Healthcare Provider Details

I. General information

NPI: 1346282902
Provider Name (Legal Business Name): KNOX FAMILY WELLNESS CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S AVENUE F
KNOX CITY TX
79529-2103
US

IV. Provider business mailing address

609 S AVENUE F
KNOX CITY TX
79529-2103
US

V. Phone/Fax

Practice location:
  • Phone: 940-657-4457
  • Fax: 940-657-4456
Mailing address:
  • Phone: 940-657-4457
  • Fax: 940-657-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1105025
License Number StateTX

VIII. Authorized Official

Name: MS. KAREN EVON STIEWERT
Title or Position: PRESIDENT
Credential: FNP-C
Phone: 940-657-4457