=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568854792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICSHARA KNIGHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2015
-----------------------------------------------------
Last Update Date | 04/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 MDG UNIT 5142
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AP
-----------------------------------------------------
Zip | 96368-5142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-634-0433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5511 KEPPLER RD
-----------------------------------------------------
City | TEMPLE HILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20748-3627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 151-836-4917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC50079054
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------