Provider Demographics
NPI:1124129465
Name:CONGLETON, TERRI D (ARNP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:D
Last Name:CONGLETON
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 1:2811 NEW HARTFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1384
Mailing Address - Country:US
Mailing Address - Phone:270-215-0234
Mailing Address - Fax:270-215-0316
Practice Address - Street 1:2811 NEW HARTFORD ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-215-0234
Practice Address - Fax:270-215-0316
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002271A363L00000X
KY4975P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK043210Medicare PIN