Provider Demographics
NPI:1205894144
Name:KNEPSHIELD, TERRY ALLEN (PAC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ALLEN
Last Name:KNEPSHIELD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CASTANA LANE
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656
Mailing Address - Country:US
Mailing Address - Phone:724-845-5637
Mailing Address - Fax:
Practice Address - Street 1:882 SR 268
Practice Address - Street 2:COWANSVILLE AREA HEALTH CENTER
Practice Address - City:COWANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16218
Practice Address - Country:US
Practice Address - Phone:724-548-7909
Practice Address - Fax:724-543-7425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0013862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA046278Medicare ID - Type Unspecified
S63876Medicare UPIN