Provider Demographics
NPI:1891780193
Name:ROBERTS, TERI LYN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LYN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LYN
Other - Last Name:OSTERKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:234 MEDICAL CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-780-2373
Practice Address - Street 1:234 MEDICAL CIR STE 1
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1194
Practice Address - Country:US
Practice Address - Phone:606-784-6641
Practice Address - Fax:606-780-2373
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-071191363LF0000X
KY3010007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3010007OtherKY MEDICAL LICENSE
IAP02669Medicare UPIN
KYK199370Medicare UPIN