Healthcare Provider Details

I. General information

NPI: 1558887703
Provider Name (Legal Business Name): TABITHA ANN KNIGHT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 07/21/2022
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PARTERRE PL
LEXINGTON KY
40504-1686
US

IV. Provider business mailing address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

V. Phone/Fax

Practice location:
  • Phone: 859-227-8656
  • Fax: 859-523-8656
Mailing address:
  • Phone: 859-278-1316
  • Fax: 859-276-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3011660
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: