Provider Demographics
NPI:1629559935
Name:NORTHCUTT, TERRIE J
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:J
Last Name:NORTHCUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-6918
Mailing Address - Country:US
Mailing Address - Phone:580-306-0248
Mailing Address - Fax:
Practice Address - Street 1:35 12TH ST SE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6006
Practice Address - Country:US
Practice Address - Phone:903-401-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185923164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse