Provider Demographics
NPI:1801851423
Name:BALES, TERRIE JEAN (MSN)
Entity Type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:JEAN
Last Name:BALES
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2727
Mailing Address - Country:US
Mailing Address - Phone:724-981-7141
Mailing Address - Fax:724-981-7763
Practice Address - Street 1:325 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2418
Practice Address - Country:US
Practice Address - Phone:724-477-5039
Practice Address - Fax:724-477-5038
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004547L363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01684774Medicaid
PA145902OtherMAGELLEN
PA002407OtherBLUE SHEID
PA01684774Medicaid