Provider Demographics
NPI:1932194321
Name:KNIGHTON, TERRY A (FNP)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:A
Last Name:KNIGHTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:803-838-0477
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:803-838-0477
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5011750001OtherCIGNA GOVERNMENT SERVICES
TXNP7584OtherBLUE CROSS BLUE SHIELD
TX156787702Medicaid
AR5UU09OtherBLUE CROSS BLUE SHIELD
TXNP7584OtherBLUE CROSS BLUE SHIELD
TX5011750001OtherCIGNA GOVERNMENT SERVICES