Healthcare Provider Details

I. General information

NPI: 1124723739
Provider Name (Legal Business Name): JEWEL KNIGHT LPN, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SUMMERLON CIR
DODGE CITY KS
67801-2985
US

IV. Provider business mailing address

2201 SUMMERLON CIR
DODGE CITY KS
67801-2985
US

V. Phone/Fax

Practice location:
  • Phone: 316-641-8678
  • Fax:
Mailing address:
  • Phone: 316-641-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13185
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number23-23184-092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: