Provider Demographics
NPI:1922315266
Name:ROBERTSON, TERANI (ARNP)
Entity Type:Individual
Prefix:
First Name:TERANI
Middle Name:
Last Name:ROBERTSON
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 1:92 JOE T PETTY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-8544
Mailing Address - Country:US
Mailing Address - Phone:270-866-8881
Mailing Address - Fax:270-866-8849
Practice Address - Street 1:92 JOE T PETTY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-8544
Practice Address - Country:US
Practice Address - Phone:270-866-8881
Practice Address - Fax:270-866-8849
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6617P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100137540Medicaid
KY6617POtherLICENSE NUMBER
KY7100137540Medicaid