1609275247 NPI number — MRS. LISA CONNER TERRY HIS, LIC#1424

Table of content: MRS. LISA CONNER TERRY HIS, LIC#1424 (NPI 1609275247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609275247 NPI number — MRS. LISA CONNER TERRY HIS, LIC#1424

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRY
Provider First Name:
LISA
Provider Middle Name:
CONNER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HIS, LIC#1424
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609275247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1506 E DIXON BLVD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
SHELBY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28152-6848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-487-1128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 E DIXON BLVD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28152-6848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-1128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1424 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com