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NPI Code Detail

MEDICARE: TERRY RIDGE NP

MEDICARE: TERRY RIDGE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner71000193AIN
2363L00000XNurse Practitioner71000193IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447345632
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY RIDGE NP
Provider Business Mailing Address
First Line : 13450 N MERIDIAN ST STE 354
Second Line :
City : CARMEL
State : IN
Zip : 46032-1486
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13450 N MERIDIAN ST STE 354
Second Line :
City : CARMEL
State : IN
Zip : 46032-1486
Country : US
Telephone Number : 317-249-0990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 08/10/2022

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