Healthcare Provider Details

I. General information

NPI: 1861084519
Provider Name (Legal Business Name): BRIANNA ALYSSE KNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E MILLTOWN RD
WOOSTER OH
44691-1331
US

IV. Provider business mailing address

721 E MILLTOWN RD # WR10
WOOSTER OH
44691-1331
US

V. Phone/Fax

Practice location:
  • Phone: 330-287-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0027545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: