Provider Demographics
NPI:1174835649
Name:MCKOWN, TERRI JEAN (FNP, APN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:JEAN
Last Name:MCKOWN
Suffix:
Gender:F
Credentials:FNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 DOUBLE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2334
Mailing Address - Country:US
Mailing Address - Phone:479-968-1418
Mailing Address - Fax:
Practice Address - Street 1:3812 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2314
Practice Address - Country:US
Practice Address - Phone:479-968-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily