Provider Demographics
NPI:1124668934
Name:PETTY, TERRIE ASHLYN (FNP)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:ASHLYN
Last Name:PETTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 FARM ROAD 195
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-2806
Mailing Address - Country:US
Mailing Address - Phone:903-739-7920
Mailing Address - Fax:
Practice Address - Street 1:1800 FARM ROAD 195
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-2806
Practice Address - Country:US
Practice Address - Phone:903-739-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX813498163W00000X
TXAP144858363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner