Individual
FREDERICK MARVIN TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2135 HENRY HILL DR STE 200, JACKSON, MS 39204-2013
(601) 942-7689
Mailing address
PO BOX 465, TERRY, MS 39170-0465
(601) 942-7689
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
890892
MS
376J00000X
Homemaker
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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