Individual
KELLY L TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-5000
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
695973
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199841102
—
TX
05
—
199841103
—
TX
05
—
199841105
—
TX
01
—
330659YN3X
MEDICARE
TX
01
—
75-1976930-005
TRICARE
TX
01
—
75-2771569-008
TRICARE
TX
01
—
8329UE
BCBS
TX
01
—
8A695U
BCBS OF TEXAS
TX
01
—
8GY772
BCBS
TX
01
—
P01290909
RAIL ROAD
TX
01
—
TIN PLUS 015
TRICARE
TX
Enumeration date
11/05/2008
Last updated
09/20/2019
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