Healthcare Provider Details

I. General information

NPI: 1306786579
Provider Name (Legal Business Name): DAVID KNOWLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W CHARLESTON BLVD
LAS VEGAS NV
89102-2335
US

IV. Provider business mailing address

1319 OGDEN AVE APT 3
DOWNERS GROVE IL
60515-1981
US

V. Phone/Fax

Practice location:
  • Phone: 702-774-2690
  • Fax:
Mailing address:
  • Phone: 731-388-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: