Provider Demographics
NPI:1780661306
Name:PIERCE, TERI LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LYNN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HILLCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1415
Mailing Address - Country:US
Mailing Address - Phone:270-422-4111
Mailing Address - Fax:270-422-3629
Practice Address - Street 1:815 HILCREST DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1415
Practice Address - Country:US
Practice Address - Phone:270-422-4111
Practice Address - Fax:270-422-3629
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3595P207Q00000X
KY3003595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78008380Medicaid
KY78008380Medicaid