Provider Demographics
NPI:1780649962
Name:HERRICK, TERRY T (APRN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:T
Last Name:HERRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:E
Other - Last Name:TIPPETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:115 HUSTON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7250
Practice Address - Country:US
Practice Address - Phone:502-955-7311
Practice Address - Fax:502-955-9694
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY009116OtherSIHO - CMA
KY000000350671OtherANTHEM - DMA
KY000052154AOtherHUMANA - CMA
KY1130950OtherPASSPORT - CMA
KY2437655000OtherPASSPORT ADVANTAGE - NMA
KY78001435Medicaid
KY1192436OtherCHA - CMA
KY009116OtherSIHO - CMA
KY1130950OtherPASSPORT - CMA