Provider Demographics
NPI:1588479265
Name:TERRY, TAMRA MICHELLE
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:MICHELLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PARKERS MILL WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-4152
Mailing Address - Country:US
Mailing Address - Phone:606-485-4003
Mailing Address - Fax:
Practice Address - Street 1:233 PARKERS MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4152
Practice Address - Country:US
Practice Address - Phone:606-485-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist