Healthcare Provider Details

I. General information

NPI: 1629559935
Provider Name (Legal Business Name): TERRIE J NORTHCUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 12TH ST SE
PARIS TX
75460-6006
US

IV. Provider business mailing address

216 OAK HILL RD
BROKEN BOW OK
74728-6918
US

V. Phone/Fax

Practice location:
  • Phone: 903-401-8958
  • Fax:
Mailing address:
  • Phone: 580-306-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number185923
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: