Healthcare Provider Details

I. General information

NPI: 1568645042
Provider Name (Legal Business Name): JESSICA ELIZABETH KNIGHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2745
US

IV. Provider business mailing address

MSC10 5610 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5851
  • Fax: 505-272-4851
Mailing address:
  • Phone: 505-272-5851
  • Fax: 505-272-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR46539
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: