Provider Demographics
NPI:1902941693
Name:MYERS, TERRI DENISE (ANP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:DENISE
Last Name:MYERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:D
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, CANP
Mailing Address - Street 1:35 MONTE VISTA LN
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5464
Mailing Address - Country:US
Mailing Address - Phone:520-921-0024
Mailing Address - Fax:
Practice Address - Street 1:35 MONTE VISTA LN
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5464
Practice Address - Country:US
Practice Address - Phone:520-921-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0293363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ748999Medicaid
AZAZ0830730OtherBCBS
AZ85240Medicare ID - Type Unspecified
AZQ28034Medicare UPIN