Provider Demographics
NPI:1750401204
Name:FORD, TERRIE M (MS ARNP)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:MS ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N TACOMA AVE
Mailing Address - Street 2:APT 805
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2622
Mailing Address - Country:US
Mailing Address - Phone:614-301-4399
Mailing Address - Fax:
Practice Address - Street 1:20 N TACOMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3133
Practice Address - Country:US
Practice Address - Phone:614-301-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60663882363LP0808X
OHRN091534163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2891652Medicaid
OHNS00681Medicare PIN