Provider Demographics
NPI:1174087068
Name:KNIGHT, MICHELLE RENAE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENAE
Last Name:KNIGHT
Suffix:
Gender:F
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:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:BUCKLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67834-0427
Mailing Address - Country:US
Mailing Address - Phone:620-338-6774
Mailing Address - Fax:
Practice Address - Street 1:203 E CENTER ST
Practice Address - Street 2:
Practice Address - City:BUCKLIN
Practice Address - State:KS
Practice Address - Zip Code:67834-3406
Practice Address - Country:US
Practice Address - Phone:620-338-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78489-102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily