Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2013034506 | MO |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 53-76136 | KS |
NPI | 1003244294 |
---|---|
Provider Name | Sue E. Terry |
First Address | Lees Summit, MO 64086-5696 |
Second Address | Riverton, KS 66770-4214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2013 |
Last Update Date | 11/03/2019 |