Healthcare Provider Details

I. General information

NPI: 1720643125
Provider Name (Legal Business Name): ALLIE KNIGHT APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE STE G800
SPRINGFIELD MO
65807-6117
US

IV. Provider business mailing address

4532 S HEMLOCK AVE
SPRINGFIELD MO
65810-1155
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number3016033
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2024031079
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: