Provider Demographics
NPI:1760485833
Name:TERKEURST, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:TERKEURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HIGHWAY 201 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3158
Mailing Address - Country:US
Mailing Address - Phone:870-424-3699
Mailing Address - Fax:870-424-3707
Practice Address - Street 1:124 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3158
Practice Address - Country:US
Practice Address - Phone:870-424-3699
Practice Address - Fax:870-424-3707
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR01557OtherHEALTH SOURCE
AR0479320001OtherPALMETTO GBA
AR117148002Medicaid
AR340002978OtherRAILROAD MCR
AR710687928OtherTX ID #
AR04D0703845OtherCLIA #
AR16020000000OtherQUALCHOICE AR #
ARC6476OtherAR LICENSE
AR115716001Medicaid
AR642613OtherFOCUS
AR642613OtherFOCUS
AR01557OtherHEALTH SOURCE
AR04D0703845OtherCLIA #
AR115716001Medicaid