Provider Demographics
NPI:1235843343
Name:SMITH-PULLIAM, TERRI LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:SMITH-PULLIAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1448
Mailing Address - Country:US
Mailing Address - Phone:270-684-5034
Mailing Address - Fax:270-685-1874
Practice Address - Street 1:2060 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1448
Practice Address - Country:US
Practice Address - Phone:270-684-5034
Practice Address - Fax:270-685-1874
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1130384163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse