Provider Demographics
NPI:1104887314
Name:AMOS, TERRI HUNT (ARNP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:HUNT
Last Name:AMOS
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 1:103 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 ANDREA ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104
Practice Address - Country:US
Practice Address - Phone:270-746-5455
Practice Address - Fax:270-746-5688
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4731P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78018199Medicaid
KY000000489598OtherANTHEM BC/BS
KY7100028630OtherMEDICAID GROUP
KY000000489598OtherANTHEM BC/BS
KY0712303Medicare ID - Type Unspecified