Provider Demographics
NPI:1316787161
Name:TERRY, ALI MAY
Entity type:Individual
Prefix:MS
First Name:ALI
Middle Name:MAY
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S ROOSEVELT ROAD AD
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9548
Mailing Address - Country:US
Mailing Address - Phone:575-760-0754
Mailing Address - Fax:844-638-0665
Practice Address - Street 1:321 S AVENUE C
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6253
Practice Address - Country:US
Practice Address - Phone:575-760-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker