Provider Demographics
NPI:1043048200
Name:TERRY, PAMALA (AGNP-C)
Entity type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7952 S REGATTA DR APT 102
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1357
Mailing Address - Country:US
Mailing Address - Phone:629-254-2678
Mailing Address - Fax:
Practice Address - Street 1:36 PEMBERTON CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-5514
Practice Address - Country:US
Practice Address - Phone:629-254-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36687363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology