Provider Demographics
NPI:1750801544
Name:HUMPHRIES, TERRY LYNN (APRN, FNP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 SPRINGCREST DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9148
Mailing Address - Country:US
Mailing Address - Phone:502-594-6102
Mailing Address - Fax:
Practice Address - Street 1:4755 HIGHWAY 31 E
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-9220
Practice Address - Country:US
Practice Address - Phone:812-282-4037
Practice Address - Fax:812-284-4038
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007152A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily