Healthcare Provider Details

I. General information

NPI: 1174087068
Provider Name (Legal Business Name): MICHELLE RENAE KNIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N 14TH AVE STE B
DODGE CITY KS
67801-2348
US

IV. Provider business mailing address

PO BOX 1513
DODGE CITY KS
67801-1513
US

V. Phone/Fax

Practice location:
  • Phone: 620-255-1410
  • Fax: 620-254-3520
Mailing address:
  • Phone: 620-255-1410
  • Fax: 620-254-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78489-102
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-78489
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: