Healthcare Provider Details

I. General information

NPI: 1295274553
Provider Name (Legal Business Name): CHUCK ANTHONY KNIGHT RN,CNOR,RNFA, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 MASONIC DR
ALEXANDRIA LA
71301-3615
US

IV. Provider business mailing address

3444 MASONIC DR
ALEXANDRIA LA
71301-3615
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-9556
  • Fax: 318-441-8339
Mailing address:
  • Phone: 318-473-9556
  • Fax: 318-441-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN109709
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224259
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: