Terri Martin Revelle, MA, LPA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3749 Issued in NC

Practice address

111 E. Jefferson St.
Jackson, NC 27845

Phone

(252) 578-3918

Fax

(252) 534-1216

NPI assigned

Aug 17, 2007

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 16, 2015.

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421366400000",
    "number": "1013109552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 PINE TOPS RD",
            "city": "MURFREESBORO",
            "state": "NC",
            "postal_code": "278559663",
            "telephone_number": "252-578-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E. JEFFERSON ST.",
            "city": "JACKSON",
            "state": "NC",
            "postal_code": "27845",
            "telephone_number": "252-578-3918",
            "fax_number": "252-534-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELLE",
        "first_name": "TERRI",
        "middle_name": "MARTIN",
        "credential": "MA, LPA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-17",
        "last_updated": "2015-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "3749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "157CH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107657",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northampton County DSS
• Northampton County School
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• Jenny Michelle Reine-Baskett, COTA
• Residential Loving Care Group Home
• Karren Boone Ricks, LCSW
• Rural Health Group, Inc.
• Rural Health Group, Inc.
• Sega Sikod, PA-C
• Lauren Simmons

• All providers in Jackson, NC
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.