Provider Demographics
NPI:1710170337
Name:KNOUSE, TINA L (RN, TXLAC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:KNOUSE
Suffix:
Gender:F
Credentials:RN, TXLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 BROADWAY BLVD
Mailing Address - Street 2:#393
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1531
Mailing Address - Country:US
Mailing Address - Phone:214-406-2210
Mailing Address - Fax:
Practice Address - Street 1:407 W I 30
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5912
Practice Address - Country:US
Practice Address - Phone:214-406-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist