Provider Demographics
NPI:1770937344
Name:MEDLOCK, TERRI (MSN WHNP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:MSN WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SPRING MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-9430
Mailing Address - Country:US
Mailing Address - Phone:812-620-1072
Mailing Address - Fax:
Practice Address - Street 1:607 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3636
Practice Address - Country:US
Practice Address - Phone:812-482-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28114242A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health