Healthcare Provider Details

I. General information

NPI: 1629736640
Provider Name (Legal Business Name): SIMONE DESHAUN KNIGHTEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

3395 KIMBERLY DR
BATON ROUGE LA
70814-2861
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax: 225-683-1310
Mailing address:
  • Phone: 504-782-3591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220347
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: