Provider Demographics
NPI:1467494005
Name:INGLE, TERI L (FNP)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:INGLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:INGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:710 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3143
Mailing Address - Country:US
Mailing Address - Phone:865-425-8802
Mailing Address - Fax:865-457-4364
Practice Address - Street 1:710 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3143
Practice Address - Country:US
Practice Address - Phone:865-425-8802
Practice Address - Fax:865-457-4364
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10673363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6349222Medicaid
TN3649222Medicare ID - Type UnspecifiedLEGACY PIN
Q28674Medicare UPIN
TN6349222Medicaid