Healthcare Provider Details

I. General information

NPI: 1457327389
Provider Name (Legal Business Name): BETHANY LANE KNIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 GRASSE STREET
CALICO ROCK AR
72519
US

IV. Provider business mailing address

PO BOX 819
CALICO ROCK AR
72519-0819
US

V. Phone/Fax

Practice location:
  • Phone: 870-297-2475
  • Fax: 870-297-4380
Mailing address:
  • Phone: 870-297-2475
  • Fax: 870-297-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC8445
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC-8445
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: