Healthcare Provider Details

I. General information

NPI: 1487722344
Provider Name (Legal Business Name): ANITA I KNIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 NC 65
WENTWORTH NC
27375
US

IV. Provider business mailing address

405 NC 65 PO BOX 355
WENTWORTH NC
27375
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-8316
  • Fax: 336-342-8352
Mailing address:
  • Phone: 336-342-8316
  • Fax: 336-342-8352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number079759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: