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General NPI Number Information
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NPI Number | 1063105120
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Entity Type | Individual
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Provider Name | DEVON T KNUPP FNP
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Gender | Male
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 10426 BAUR BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1905
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Country | US
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Telephone | 314-925-0903
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Fax |
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Provider Business Mailing Address
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Address Line | 2326 WINDSOR CASTLE DR
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City | IMPERIAL
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State | MO
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Zip | 63052-2014
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Country | US
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Telephone | 636-692-3012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023024713
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License Number State | MO
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