Healthcare Provider Details

I. General information

NPI: 1477049864
Provider Name (Legal Business Name): MALLORY ELAINE KNOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13650 E MISSISSIPPI AVE
AURORA CO
80012-3561
US

IV. Provider business mailing address

290 S CLARKSON ST
DENVER CO
80209-2124
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-1338
  • Fax:
Mailing address:
  • Phone: 913-624-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0993971-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: