Provider Demographics
NPI:1710274907
Name:CORE, TERRI JEAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:JEAN
Last Name:CORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S CLIFTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2963
Mailing Address - Country:US
Mailing Address - Phone:316-462-1040
Mailing Address - Fax:
Practice Address - Street 1:1131 S CLIFTON AVE STE B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2963
Practice Address - Country:US
Practice Address - Phone:316-462-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45157363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care