1174754485 NPI number — TRACY FEY TERRELL APRN

Table of content: (NPI 1326005513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174754485 NPI number — TRACY FEY TERRELL APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRELL
Provider First Name:
TRACY
Provider Middle Name:
FEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174754485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 CROWN POINTE DR STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-7280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-506-3300
Provider Business Practice Location Address Fax Number:
270-506-2843
Provider Enumeration Date:
08/04/2009

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: 363LF0000X , with the licence number:  3006100 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000001274704 . This is a "ANTHEM PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100078870 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1865831 . This is a "WELLCARE OF KENTUCKY PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 304651KYIP . This is a "AETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3060245 . This is a "UNITED HEALTHCARE PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P02312324 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CS1918600189 . This is a "CARESOURCE PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10576522 . This is a "PRIME HEALTH SERVICES PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201018200 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8379074 . This is a "CIGNA PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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