Healthcare Provider Details

I. General information

NPI: 1164832234
Provider Name (Legal Business Name): KATHY KNIGHT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LENOIR HALL UNIVERSITY OF MS
UNIVERSITY MS
38677
US

IV. Provider business mailing address

616 S 11TH ST
OXFORD MS
38655-4310
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-8662
  • Fax: 662-915-8663
Mailing address:
  • Phone: 661-816-7692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD0206
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: