Provider Demographics
NPI:1982446092
Name:TERWILLIGER, KELLY (IHP, CPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TERWILLIGER
Suffix:
Gender:F
Credentials:IHP, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15492 BOOKER TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1600
Mailing Address - Country:US
Mailing Address - Phone:310-995-1469
Mailing Address - Fax:
Practice Address - Street 1:15492 BOOKER TRL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-1600
Practice Address - Country:US
Practice Address - Phone:310-995-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach