Healthcare Provider Details

I. General information

NPI: 1124003801
Provider Name (Legal Business Name): PATSY O MCKNIGHT F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127E MAIN ST
INDEPENDENCE VA
24348-3985
US

IV. Provider business mailing address

PO BOX 947
INDEPENDENCE VA
24348-0947
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-2865
  • Fax: 276-773-0843
Mailing address:
  • Phone: 276-773-2865
  • Fax: 276-773-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024000073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: