Provider Demographics
NPI:1932584117
Name:TERRY, BOBBIE JEAN
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:TERRY
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 1:806 SPRINGRIDGE RD
Mailing Address - Street 2:APT. D
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5644
Mailing Address - Country:US
Mailing Address - Phone:601-953-2591
Mailing Address - Fax:
Practice Address - Street 1:806 SPRINGRIDGE RD
Practice Address - Street 2:APT. D
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5644
Practice Address - Country:US
Practice Address - Phone:601-953-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20107403364SA2200X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No376J00000XNursing Service Related ProvidersHomemaker