Provider Demographics
NPI:1326232448
Name:TERRY, LISA H (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:TERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-4504
Mailing Address - Country:US
Mailing Address - Phone:618-524-1740
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 209B
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4610
Practice Address - Fax:270-441-4608
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5324P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000545288OtherBLUE CROSS BLUE SHIELD
KY1840003Medicare PIN