=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295300838
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNY WAYNE KNIGHTEN APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2021
-----------------------------------------------------
Last Update Date | 05/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 AVENUE J
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79401-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-743-2686
-----------------------------------------------------
Fax | 806-796-0569
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2610 AVENUE V
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79411-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-885-5813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 1034552
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------