=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366976557
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LA'KITA MARIA JOHNSON KNIGHT FNP-C, MSN, BSN, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14121 PARKE LONG CT
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-657-8523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 EQUIPOISE DR
-----------------------------------------------------
City | INDIAN TRAIL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28079-8493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-779-4326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 232250
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------