Provider Demographics
NPI:1790973790
Name:FORSS, TERRY ANN (NP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:FORSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:ANN
Other - Last Name:FORSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-497-6330
Mailing Address - Fax:317-497-6334
Practice Address - Street 1:333 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1079
Practice Address - Country:US
Practice Address - Phone:317-497-6371
Practice Address - Fax:317-497-6334
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28116399A363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01291553OtherRAILROAD MEDICARE
INP01291553OtherRAILROAD MEDICARE