Healthcare Provider Details

I. General information

NPI: 1053220624
Provider Name (Legal Business Name): TERI FETTERS MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WESLEY HILLS DR
FORT THOMAS KY
41075-1213
US

IV. Provider business mailing address

15 WESLEY HILLS DR
FORT THOMAS KY
41075-1213
US

V. Phone/Fax

Practice location:
  • Phone: 859-803-4630
  • Fax:
Mailing address:
  • Phone: 859-803-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1093182
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: