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NPI Code Detail

MEDICARE: MYSTI MICHELLE KNIGHT-COBLE

MEDICARE: MYSTI MICHELLE KNIGHT-COBLE
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1447987052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYSTI MICHELLE KNIGHT-COBLE
Provider Business Mailing Address
First Line : 1477 E SANTIAGO LN APT 31
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-7252
Country : US
Telephone Number : 385-315-0025
Fax Number :
Provider Business Practice Location Address
First Line : 855 E 4800 S STE 100
Second Line :
City : MURRAY
State : UT
Zip : 84107-5513
Country : US
Telephone Number : 801-473-3963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2022
Last Update Date : 08/03/2022

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Directions to “ MYSTI MICHELLE KNIGHT-COBLE ” Practice Location

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