Healthcare Provider Details

I. General information

NPI: 1801594387
Provider Name (Legal Business Name): JAZMIN KNIGHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER ROAD NORTH
BETHESDA MD
20814-2081
US

IV. Provider business mailing address

2910 SHUMARD OAK LN UNIT 204
WOODBRIDGE VA
22191-7537
US

V. Phone/Fax

Practice location:
  • Phone: 571-456-8589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: