Healthcare Provider Details

I. General information

NPI: 1912359415
Provider Name (Legal Business Name): MICHAEL KNOTTS MSN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 HIGHWAY 614
MOSS POINT MS
39562-6483
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-588-6622
  • Fax: 228-588-9399
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901568
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: