Individual
DONNA TERRY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8383 MILLICENT WAY, SHREVEPORT, LA 71115-5207
(318) 797-6661
Mailing address
PO BOX 5687, SHREVEPORT, LA 71135-5687
(318) 797-6661
(318) 795-8512
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10282
LA
Other
Enumeration date
07/07/2005
Last updated
07/08/2007
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