Healthcare Provider Details

I. General information

NPI: 1184862120
Provider Name (Legal Business Name): WHITNEY KNOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 STONE ST
JONESBORO AR
72401-4520
US

IV. Provider business mailing address

2206 NEEDHAM ST APT. #4
JONESBORO AR
72401-7209
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9528
  • Fax: 870-933-9778
Mailing address:
  • Phone: 870-972-1268
  • Fax: 870-934-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: