Healthcare Provider Details

I. General information

NPI: 1316560204
Provider Name (Legal Business Name): DANIEL KNIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 10/27/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W. PARK AVE
ASH FORK AZ
86320-8632
US

IV. Provider business mailing address

419 S 3RD ST
WILLIAMS AZ
86046-2448
US

V. Phone/Fax

Practice location:
  • Phone: 855-277-5901
  • Fax: 949-577-4681
Mailing address:
  • Phone: 855-277-5901
  • Fax: 949-577-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIEL B KNIGHT
Title or Position: OWNER / CEO / PROVIDER
Credential: FNP
Phone: 855-277-5901