Provider Demographics
NPI:1174754485
Name:TERRELL, TRACY FEY (APRN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:FEY
Last Name:TERRELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1107 CROWN POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7280
Practice Address - Country:US
Practice Address - Phone:270-506-3300
Practice Address - Fax:270-506-2843
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006100363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001274704OtherANTHEM PROVIDER ID NUMBER
KY7100078870Medicaid
KY1865831OtherWELLCARE OF KENTUCKY PROVIDER ID
KY304651KYIPOtherAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER
3060245OtherUNITED HEALTHCARE PROVIDER ID
KYP02312324OtherRAILROAD MEDICARE
CS1918600189OtherCARESOURCE PROVIDER ID NUMBER
10576522OtherPRIME HEALTH SERVICES PROVIDER ID NUMBER
IN201018200Medicaid
8379074OtherCIGNA PROVIDER ID NUMBER