Provider Demographics
NPI:1710729074
Name:TERHARK, KARLY PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:PAIGE
Last Name:TERHARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:P
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-602-9833
Mailing Address - Fax:319-343-1161
Practice Address - Street 1:1924 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-3146
Practice Address - Country:US
Practice Address - Phone:515-832-3332
Practice Address - Fax:515-832-1114
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant