Healthcare Provider Details

I. General information

NPI: 1891063301
Provider Name (Legal Business Name): EBONY YVETTE MCKNIGHT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 11/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 140
BEVERLY HILLS CA
90210-4731
US

IV. Provider business mailing address

415 N CRESCENT DR STE 140
BEVERLY HILLS CA
90210-4731
US

V. Phone/Fax

Practice location:
  • Phone: 310-246-0702
  • Fax: 310-246-0672
Mailing address:
  • Phone: 310-246-0702
  • Fax: 310-246-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336952
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21723
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606430
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: