Provider Demographics
NPI:1699943399
Name:PRATT, TERRY LYNN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LYNN
Last Name:PRATT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 MR JOE WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6712
Mailing Address - Country:US
Mailing Address - Phone:843-918-2040
Mailing Address - Fax:843-839-9325
Practice Address - Street 1:3127 MR JOE WHITE AVE
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6712
Practice Address - Country:US
Practice Address - Phone:843-918-2040
Practice Address - Fax:843-839-9325
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO094051363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCP9133OtherRAILROAD MEDICARE
MOP00480402OtherRAILROAD MEDICARE
MO428397905Medicaid
MO837700607Medicare PIN