Provider Demographics
NPI:1437126570
Name:KNEPP, TERA L (FNP)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:L
Last Name:KNEPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEMORIAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-3154
Mailing Address - Country:US
Mailing Address - Phone:812-254-2400
Mailing Address - Fax:812-254-3191
Practice Address - Street 1:1401 MEMORIAL AVE STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3154
Practice Address - Country:US
Practice Address - Phone:812-254-2400
Practice Address - Fax:812-254-3191
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002022A363L00000X, 363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP1660790OtherRRMCR
IN000000390526OtherANTHEM
IN200800420Medicaid
INDQ1052OtherGROUP RRMCR
IN000000390526OtherANTHEM
IN265260001Medicare PIN
INP00358177OtherMEDICARE RAILROAD