Healthcare Provider Details

I. General information

NPI: 1427570555
Provider Name (Legal Business Name): DANIELE WILSON KNIGHT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 11/08/2021
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12589 AIRLINE HWY
DESTREHAN LA
70047-2501
US

IV. Provider business mailing address

12589 AIRLINE HWY
DESTREHAN LA
70047-2501
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-1158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09414
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: