Provider Demographics
NPI:1134090319
Name:STEPHENS-TERRELL, TERRY PATRICE
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:PATRICE
Last Name:STEPHENS-TERRELL
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 1:3005 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-4022
Mailing Address - Country:US
Mailing Address - Phone:225-207-7473
Mailing Address - Fax:
Practice Address - Street 1:3005 DAYTON ST & REMOTE LOCATIONS, MILITARY BASES
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-4022
Practice Address - Country:US
Practice Address - Phone:225-207-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-NA1710I1002X
GACN0014256052171W00000X
AL171400000X
LA174H00000X, 183700000X
LA318362251E00000X
OK320837880125251J00000X
OK253Z00000X
MOPA-NA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No171W00000XOther Service ProvidersContractor
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No183700000XPharmacy Service ProvidersPharmacy Technician
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care