Provider Demographics
NPI:1114123924
Name:SMITH, TERI L (ACNP)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:L
Other - Last Name:ENGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3157
Mailing Address - Fax:812-242-3861
Practice Address - Street 1:1530 N 7TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1059
Practice Address - Country:US
Practice Address - Phone:812-238-7892
Practice Address - Fax:812-238-7509
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001607A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care