Healthcare Provider Details

I. General information

NPI: 1912116096
Provider Name (Legal Business Name): JANICE KNOWLTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 SILLECT AVE SUITE 240
BAKERSFIELD CA
93308-6340
US

IV. Provider business mailing address

3008 SILLECT AVE SUITE 240
BAKERSFIELD CA
93308-6340
US

V. Phone/Fax

Practice location:
  • Phone: 661-616-9300
  • Fax: 661-616-9301
Mailing address:
  • Phone: 661-616-9300
  • Fax: 661-616-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: