Healthcare Provider Details

I. General information

NPI: 1326854514
Provider Name (Legal Business Name): KNO'QOTI NATIVE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S MAIN ST
LAKEPORT CA
95453-5510
US

IV. Provider business mailing address

809 S MAIN ST
LAKEPORT CA
95453-5510
US

V. Phone/Fax

Practice location:
  • Phone: 707-900-2121
  • Fax:
Mailing address:
  • Phone: 707-900-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KYLE BILL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-900-2121