MEDICARE: KATIE LYNN KNOX RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	731560-1	NY

General Provider Information

NPI Number	:	1417621210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE LYNN KNOX RN

Provider Business Mailing Address
First Line	:	6356 NEWPORT RD
Second Line	:
City	:	WARNERS
State	:	NY
Zip	:	13164-9705
Country	:	US
Telephone Number	:	315-704-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 PATRICIA DR
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4272
Country	:	US
Telephone Number	:	315-383-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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