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General NPI Number Information
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NPI Number | 1215386396
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Entity Type | Individual
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Provider Name | KRYSTAL KNIGHT NP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7694
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Country | US
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Telephone | 678-312-2418
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Fax |
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Provider Business Mailing Address
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Address Line | 631 PROFESSIONAL DR STE 120
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3370
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Country | US
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Telephone | 678-312-3290
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Fax | 678-312-2733
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN165295
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN165295
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | RN165295
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License Number State | GA
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