MEDICARE: MR. TERRY DAVID PANNELL RN

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
1	363LF0000X	Family Nurse Practitioner	4014805	KY

General Provider Information

NPI Number	:	1659611655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY DAVID PANNELL RN

Provider Business Mailing Address
First Line	:	12904 ROBERT L MADON BYP # 2
Second Line	:
City	:	PINEVILLE
State	:	KY
Zip	:	40977-8063
Country	:	US
Telephone Number	:	606-598-4508
Fax Number	:	606-599-2521

Provider Business Practice Location Address
First Line	:	12904 ROBERT L MADON BYP STE 2
Second Line	:
City	:	PINEVILLE
State	:	KY
Zip	:	40977-8063
Country	:	US
Telephone Number	:	606-302-0054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	06/25/2024

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