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General NPI Number Information
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NPI Number | 1407165756
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Entity Type | Individual
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Provider Name | NICOLE MCKNIGHT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 8935 SE POWELL BLVD
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City | PORTLAND
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State | OR
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Zip | 97266
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Country | US
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Telephone | 503-772-4335
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Fax | 503-772-4337
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Provider Business Mailing Address
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Address Line | 8935 SE POWELL BLVD
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City | PORTLAND
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State | OR
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Zip | 97266-1938
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Country | US
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Telephone | 503-772-4335
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Fax | 503-772-4337
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201709785RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5004889
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201710254NP-PP
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License Number State | OR
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