Provider Demographics
NPI:1659611655
Name:PANNELL, TERRY DAVID (RN)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DAVID
Last Name:PANNELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12904 ROBERT L MADON BYP # 2
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-8063
Mailing Address - Country:US
Mailing Address - Phone:606-302-0054
Mailing Address - Fax:
Practice Address - Street 1:12904 ROBERT L MADON BYP STE 2
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8063
Practice Address - Country:US
Practice Address - Phone:606-302-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4014805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily