1932194321 NPI number — MR. TERRY A KNIGHTON FNP

Table of content: DEBRA L. KOUTNIK MD (NPI 1467441006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932194321 NPI number — MR. TERRY A KNIGHTON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHTON
Provider First Name:
TERRY
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932194321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4105 N KINGS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-4861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-838-0444
Provider Business Mailing Address Fax Number:
803-838-0477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4105 N KINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-4861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-838-0444
Provider Business Practice Location Address Fax Number:
803-838-0477
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  595495 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5011750001 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NP7584 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 156787702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5UU09 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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