Healthcare Provider Details

I. General information

NPI: 1083852131
Provider Name (Legal Business Name): SARA AILEEN KNIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/25/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMPERE'S NURSING HOME 865 NORTH ST
JACKSON MS
39202
US

IV. Provider business mailing address

213 SILAS TRCE
RIDGELAND MS
39157-9743
US

V. Phone/Fax

Practice location:
  • Phone: 601-206-0901
  • Fax: 888-240-6288
Mailing address:
  • Phone: 601-506-4442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR857908
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: