Healthcare Provider Details

I. General information

NPI: 1609803683
Provider Name (Legal Business Name): JEANNETTE KIGHT MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MHM SBHC 217 WEST OTTO ST
MARION TX
78124
US

IV. Provider business mailing address

5206 CATTLEMAN ST
SAN ANTONIO TX
78247-1901
US

V. Phone/Fax

Practice location:
  • Phone: 830-914-2803
  • Fax:
Mailing address:
  • Phone: 210-410-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number664471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: