Provider Demographics
NPI:1679284426
Name:TERRY, KIRBIE STRATTON (PA)
Entity type:Individual
Prefix:
First Name:KIRBIE
Middle Name:STRATTON
Last Name:TERRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIRBIE
Other - Middle Name:DANIELLE
Other - Last Name:STRATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16230 COUNTY ROAD 673
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-3316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4501 JOE RAMSEY BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7843
Practice Address - Country:US
Practice Address - Phone:903-408-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA16639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program