Provider Demographics
NPI:1437592748
Name:SPECK, TERRI L (NP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:SPECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 SW WILSHIRE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8717
Mailing Address - Country:US
Mailing Address - Phone:817-295-1121
Mailing Address - Fax:817-295-8170
Practice Address - Street 1:1571 SW WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8717
Practice Address - Country:US
Practice Address - Phone:817-295-1121
Practice Address - Fax:817-295-8170
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123360364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310398YUAKMedicare PIN