Provider Demographics
NPI:1144228040
Name:MCPHERSON, TERRY LYNN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:
Practice Address - Street 1:510 RUBY DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2168
Practice Address - Country:US
Practice Address - Phone:270-399-7900
Practice Address - Fax:270-399-7910
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA757363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000201489OtherANTHEM OF KY
IN100329260BMedicaid
P400033473OtherMEDICARE PTAN
KY970031073Medicare ID - Type UnspecifiedRAILROAD
KYP43569Medicare UPIN
P400033473OtherMEDICARE PTAN