Healthcare Provider Details

I. General information

NPI: 1891815106
Provider Name (Legal Business Name): TERRIEST VONCEILE HAIRE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 MCCALLIE AVE SUITE 100
CHATTANOOGA TN
37403-2800
US

IV. Provider business mailing address

PO BOX 1844
SPRING HILL TN
37174-1844
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-4588
  • Fax: 865-342-0103
Mailing address:
  • Phone: 615-224-8066
  • Fax: 888-794-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number677957
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN178773
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN20009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: