Healthcare Provider Details

I. General information

NPI: 1992959282
Provider Name (Legal Business Name): RICHARD GERHARD KNIGHT MSN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E HIGHWAY 50
O FALLON IL
62269-2704
US

IV. Provider business mailing address

2620 ODIN RD
ODIN IL
62870-2404
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-3368
  • Fax: 618-624-3387
Mailing address:
  • Phone: 618-322-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.007.252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: