Healthcare Provider Details

I. General information

NPI: 1780538538
Provider Name (Legal Business Name): JENNIFER KNOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 LOCUST ST
RED BUD IL
62278-1123
US

IV. Provider business mailing address

4740 KANE HILL RD
ELLIS GROVE IL
62241-1728
US

V. Phone/Fax

Practice location:
  • Phone: 573-880-5828
  • Fax:
Mailing address:
  • Phone: 618-615-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026037039
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: