Healthcare Provider Details

I. General information

NPI: 1992617807
Provider Name (Legal Business Name): KNOWLEVITY PSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N HIGHWAY A1A STE 104
JUPITER FL
33477-4571
US

IV. Provider business mailing address

725 N HIGHWAY A1A STE 104
JUPITER FL
33477-4571
US

V. Phone/Fax

Practice location:
  • Phone: 728-215-6974
  • Fax:
Mailing address:
  • Phone: 728-215-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THAI LE
Title or Position: OWNER
Credential:
Phone: 728-215-6974