Healthcare Provider Details

I. General information

NPI: 1619827565
Provider Name (Legal Business Name): JEAN MARIE KNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W D.L. INGRAM AVE BUILDING 1408 CANNON AFB
CLOVIS NM
88103
US

IV. Provider business mailing address

521 MERRILL DR
CLOVIS NM
88101-4053
US

V. Phone/Fax

Practice location:
  • Phone: 575-904-3917
  • Fax:
Mailing address:
  • Phone: 575-714-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: