Provider Demographics
NPI:1497831473
Name:LAWSON, TERRI LANETTE (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LANETTE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2340 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4108
Practice Address - Country:US
Practice Address - Phone:765-452-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001341A363LF0000X
IN71001341363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01014118OtherRR MEDICARE PTAN
IN200460230Medicaid
INP01014118OtherRR MEDICARE PTAN
IN200460230Medicaid
INM400038244Medicare PIN
IN191690AMedicare PIN
INM400038246Medicare PIN
INM400038241Medicare PIN
INM400038245Medicare PIN
INM400038251Medicare PIN
INM400054456Medicare PIN
IN265900GMedicare PIN