Provider Demographics
NPI:1487618203
Name:KLEIN, TERRIE L (FNP)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:L
Last Name:KLEIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TERRIE
Other - Middle Name:ANN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4102 24TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-725-4676
Practice Address - Fax:806-723-6731
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243809363L00000X
TXAP113436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172116901Medicaid
TX8D35111OtherMEDICARE
TX8Y0995OtherBCBS
TX143531100OtherFIRSTCARE
NM16554311Medicaid
TXP01495180OtherRAILROAD MEDICARE