Basic Information
| Provider Information | |||||||||
| NPI: | 1003244294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERRY | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 NE TUDOR RD | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640865696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882563814 | ||||||||
| FaxNumber: | 8882569054 | ||||||||
| Practice Location | |||||||||
| Address1: | 6524 SE QUAKERVALE RD | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667704214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208482380 | ||||||||
| FaxNumber: | 6208482381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2013034506 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 53-76136 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.