Provider Demographics
NPI:1598585887
Name:TERRELL, KARSYN
Entity type:Individual
Prefix:
First Name:KARSYN
Middle Name:
Last Name:TERRELL
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-0099
Mailing Address - Country:US
Mailing Address - Phone:580-661-3488
Mailing Address - Fax:580-661-3487
Practice Address - Street 1:PO BOX 99
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669-0099
Practice Address - Country:US
Practice Address - Phone:580-661-3488
Practice Address - Fax:580-661-3487
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK475047832171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator