Provider Demographics
NPI:1588161889
Name:GRANT, TERRILYN (LVN)
Entity type:Individual
Prefix:
First Name:TERRILYN
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6899 COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:TX
Mailing Address - Zip Code:78343-3282
Mailing Address - Country:US
Mailing Address - Phone:361-522-7777
Mailing Address - Fax:
Practice Address - Street 1:800 N SHORELINE BLVD STE 700S
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3718
Practice Address - Country:US
Practice Address - Phone:361-937-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165875164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse