Healthcare Provider Details

I. General information

NPI: 1275940835
Provider Name (Legal Business Name): KARRISSA ELIZABETH KNIGHT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARRISSA EZELL

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PENN AVE
HARRISVILLE WV
26362-1371
US

IV. Provider business mailing address

502 STANLEY AVE
CLARKSBURG WV
26301-3126
US

V. Phone/Fax

Practice location:
  • Phone: 304-643-4005
  • Fax:
Mailing address:
  • Phone: 304-481-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN83676-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: