Healthcare Provider Details

I. General information

NPI: 1053700443
Provider Name (Legal Business Name): JENNIFER KNIGHT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 MONTREAT CIR APT A
VESTAVIA AL
35216-3966
US

IV. Provider business mailing address

PO BOX 288
HUNTSVILLE AL
35804-0288
US

V. Phone/Fax

Practice location:
  • Phone: 205-603-5675
  • Fax:
Mailing address:
  • Phone: 256-880-6711
  • Fax: 256-880-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01350
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: