NPIMap

Individual provider Active NPI

Terani Robertson, ARNP

  • Family Nurse Practitioner
  • Russell Springs, KY
National Provider Identifier
1922315266
Registry record updated Jun 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
6617P Issued in KY
Practice address
92 Joe T Petty Dr
Suite 400
Russell Springs, KY 42642-8544
Phone
(270) 866-8881
Fax
(270) 866-8849
NPI assigned
Sep 8, 2010
Last updated
Jun 9, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 6617P KY Primary

Addresses

Primary practice location

92 Joe T Petty Dr
Suite 400
Russell Springs, KY 42642-8544

Mailing address

92 Joe T Petty Dr
Suite 400
Russell Springs, KY 42642-8544
Phone (270) 866-8881

Other identifiers 2

IdentifierTypeStateIssuer
6617POtherKYLICENSE NUMBER
7100137540MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120430000362 KY Practitioner - Nurse Practitioner 3274795786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Kentucky College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Russell County HospitalGroup PAC ID 6204887243, 22 clinicians

Practice addresses (Care Compare)

124 Dowell Rd
Russell Springs, KY 42642-4235

153 Dowell Rd
Russell Springs, KY 42642-4579
Phone (270) 866-4141

169 Joe T Petty Dr
Russell Springs, KY 42642-8533
Phone (270) 865-1002

PO Box
Suite 1610
Russell Springs, KY 42642

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6617PKYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Russell County Hospital CurrentSince Mar 19, 2014 Accepting new patients
Russell County Hospital Current Accepting new patients
Russell County Hospital CurrentSince Mar 19, 2014 Accepting new patients
Nexus Lab Inc PastSince Mar 25, 2012 Accepting new patients

Locations

153 Dowell Rd
Russell Springs, KY 42642
Phone (270) 866-4141

92 Joe T Petty Dr
Russell Springs, KY 42642
Phone (270) 866-7611

92 Joe T Petty Dr
Ste 400
Russell Springs, KY 42642
Phone (270) 866-8881

Interoperability endpoints

  • Direct secure messaging: terani.robertson@crch.eclinicaldirectplus.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433808000000",
    "number": "1922315266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 JOE T PETTY DR",
            "address_2": "SUITE 400",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426428544",
            "telephone_number": "270-866-8881",
            "fax_number": "270-866-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 JOE T PETTY DR",
            "address_2": "SUITE 400",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426428544",
            "telephone_number": "270-866-8881",
            "fax_number": "270-866-8849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "TERANI",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-08",
        "last_updated": "2015-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "6617P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "6617P",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100137540",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russell Springs, KY

Sources for this page

Verify at the official NPI Registry.