Healthcare Provider Details

I. General information

NPI: 1932413390
Provider Name (Legal Business Name): LEAH DIANE KNIGHT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ILLINOIS ST
INDIANAPOLIS IN
46202-1316
US

IV. Provider business mailing address

1931 S RILEY HWY
SHELBYVILLE IN
46176-2861
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-5135
  • Fax: 317-931-5113
Mailing address:
  • Phone: 317-512-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number71003300A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: