Basic Information
| Provider Information | |||||||||
| NPI: | 1558649905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLICK | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 LELA ST | ||||||||
| Address2: | |||||||||
| City: | MANGHAM | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712595063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182484100 | ||||||||
| FaxNumber: | 3182484103 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 LELA ST | ||||||||
| Address2: | |||||||||
| City: | MANGHAM | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712595063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182484100 | ||||||||
| FaxNumber: | 3182484103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP06543 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.