Provider Demographics
NPI:1932502218
Name:TERRELL, CONNIE JOELLEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JOELLEN
Last Name:TERRELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 STEIN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1690
Mailing Address - Country:US
Mailing Address - Phone:423-867-4969
Mailing Address - Fax:423-648-8481
Practice Address - Street 1:2000 STEIN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1690
Practice Address - Country:US
Practice Address - Phone:423-648-8480
Practice Address - Fax:423-648-8481
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6031898OtherBCBS OF TENNESSEE
TNQ010303Medicaid
TN10350I4354Medicare PIN