Individual
KERRY L TERRAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
164X00000X
Contact information
Practice address
1301 SE 22ND AVE, MINERAL WELLS, TX 76067-6777
(940) 468-2083
Mailing address
1314 LAKE ST STE 101, FORT WORTH, TX 76102-4582
(325) 320-8301
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
311949
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311949
TEXAS BON
TX
Enumeration date
02/16/2018
Last updated
02/16/2018
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