Healthcare Provider Details

I. General information

NPI: 1205833621
Provider Name (Legal Business Name): MICHELE KNAPIK-SMITH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 VARDEN DR
AIKEN SC
29803-5285
US

IV. Provider business mailing address

33 VARDEN DR
AIKEN SC
29803-5285
US

V. Phone/Fax

Practice location:
  • Phone: 803-642-3801
  • Fax: 803-642-5538
Mailing address:
  • Phone: 803-642-3801
  • Fax: 803-642-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN082188
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN567
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: