Provider Demographics
NPI:1285003970
Name:HARRILD, TERRICK (PA)
Entity type:Individual
Prefix:
First Name:TERRICK
Middle Name:
Last Name:HARRILD
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1515 N 400 E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7561
Mailing Address - Country:US
Mailing Address - Phone:435-757-6061
Mailing Address - Fax:435-994-8362
Practice Address - Street 1:75 YELLOW CREEK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5235
Practice Address - Country:US
Practice Address - Phone:307-789-8290
Practice Address - Fax:307-789-8975
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2016-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDP-1294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant