Healthcare Provider Details

I. General information

NPI: 1447041256
Provider Name (Legal Business Name): JODI LEA KNOWLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CASA ST STE 170
SAN LUIS OBISPO CA
93405-1887
US

IV. Provider business mailing address

35 CASA ST STE 170
SAN LUIS OBISPO CA
93405-1887
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-0644
  • Fax: 661-846-4940
Mailing address:
  • Phone: 800-763-7732
  • Fax: 805-369-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: