Provider Demographics
NPI:1699213454
Name:FREEMAN, TERYN ARDELL (PA)
Entity type:Individual
Prefix:MRS
First Name:TERYN
Middle Name:ARDELL
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TERYN
Other - Middle Name:
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIT 3215 BOX APO
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094-3215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 3215 BOX APO
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094-3215
Practice Address - Country:US
Practice Address - Phone:731-479-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699213454OtherMILITARY