1457342081 NPI number — DR. KRISTINE ELIZABETH TERRY PHD

Table of content: DR. KRISTINE ELIZABETH TERRY PHD (NPI 1457342081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457342081 NPI number — DR. KRISTINE ELIZABETH TERRY PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRY
Provider First Name:
KRISTINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457342081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 S RIVER ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PLAINS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18705-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-287-1301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 S RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-287-1301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS008326L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2101564 . This is a "CIGNA BEH HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 815349 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".