Healthcare Provider Details

I. General information

NPI: 1437126570
Provider Name (Legal Business Name): TERA L KNEPP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEMORIAL AVE STE B
WASHINGTON IN
47501-3154
US

IV. Provider business mailing address

1401 MEMORIAL AVE STE B
WASHINGTON IN
47501-3154
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2400
  • Fax: 812-254-3191
Mailing address:
  • Phone: 812-254-2400
  • Fax: 812-254-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71002022A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number71002022A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71002022A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: