Provider Demographics
NPI:1053576405
Name:BROWN, TERRI LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:LEE
Other - Last Name:MICHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-0230
Mailing Address - Country:US
Mailing Address - Phone:812-268-3318
Mailing Address - Fax:
Practice Address - Street 1:2229 MARY SHERMAN DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7633
Practice Address - Country:US
Practice Address - Phone:812-268-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002697A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00834946OtherRAILROAD MEDICARE
IN192770D1Medicare PIN
IN265130B1Medicare PIN
IN859910F9Medicare PIN