Individual
TERI A PAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
701 N PRICE RD, PAMPA, TX 79065-5126
(806) 688-2273
(806) 665-0537
Mailing address
916 N CREST RD, PAMPA, TX 79065-2798
(806) 662-3613
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
739475
TX
363L00000X
Nurse Practitioner
45736
KS
363L00000X
Nurse Practitioner
Primary
739475
TX
363LP0200X
Pediatric Nurse Practitioner
739475
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01409751
—
NM
01
—
161690
BCBS
KS
05
—
200308720 A
—
OK
05
—
200347480C
—
KS
05
—
201311202
—
TX
05
—
201311203
—
TX
Enumeration date
07/02/2006
Last updated
02/15/2017
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