Provider Demographics
NPI:1710267067
Name:ROBERTS, TERRY ANNE (MSN, FNP, BC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSN, FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-525-3334
Mailing Address - Fax:
Practice Address - Street 1:6350 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1232
Practice Address - Country:US
Practice Address - Phone:304-399-3350
Practice Address - Fax:304-955-5047
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024274Medicaid
WVWV3180C830Medicare PIN
WVWV3180C455Medicare PIN
WVWV3180C595Medicare PIN
WVWV3180C604Medicare PIN
WVWV3180BMedicare PIN
WVWV3180C437Medicare PIN
WVWV3180C196Medicare PIN
WVWV3180C729Medicare PIN
WVWV3180CMedicare PIN
WVWV3180C197Medicare PIN