Healthcare Provider Details

I. General information

NPI: 1811954811
Provider Name (Legal Business Name): MISS VICKIE KNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BARNES BLVD
MCCHORD AFB WA
98438
US

IV. Provider business mailing address

8509 160TH STREET CT E
PUYALLUP WA
98375-9665
US

V. Phone/Fax

Practice location:
  • Phone: 253-982-6079
  • Fax:
Mailing address:
  • Phone: 253-861-6472
  • Fax: 253-982-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00143530
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: