Provider Demographics
NPI:1578510970
Name:TERRY, LISA ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:TERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:GRISSOM
Other - Last Name:PEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1453 HOPE WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3140
Mailing Address - Country:US
Mailing Address - Phone:615-893-9390
Mailing Address - Fax:615-893-4162
Practice Address - Street 1:1453 HOPE WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3140
Practice Address - Country:US
Practice Address - Phone:615-893-9390
Practice Address - Fax:615-893-4162
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908318Medicaid
TN3908318Medicare ID - Type UnspecifiedCIGNA MEDICARE
TN3908318Medicaid