Healthcare Provider Details

I. General information

NPI: 1346949625
Provider Name (Legal Business Name): KRISTIN MARIE MCKNIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST STE 4474
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

2108 N ST STE 4474
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 510-456-0765
  • Fax: 833-232-6454
Mailing address:
  • Phone: 510-456-0765
  • Fax: 833-232-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95241390
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN97259
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN97259
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95241390
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN97259
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: