Provider Demographics
NPI:1700208055
Name:KNIGHTON CENTER PLLC
Entity Type:Organization
Organization Name:KNIGHTON CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:903-838-0444
Mailing Address - Street 1:4105 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4861
Mailing Address - Country:US
Mailing Address - Phone:903-838-0444
Mailing Address - Fax:903-838-0477
Practice Address - Street 1:4105 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4861
Practice Address - Country:US
Practice Address - Phone:903-838-0444
Practice Address - Fax:903-838-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty