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General NPI Number Information
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NPI Number | 1588210884
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Entity Type | Individual
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Provider Name | JACLYN MICHELLE KNIGHT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 454 E MEDICAL WAY
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City | HEBER CITY
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State | UT
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Zip | 84032-1391
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Country | US
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Telephone | 801-787-6209
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Fax |
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Provider Business Mailing Address
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Address Line | 454 E MEDICAL WAY
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City | HEBER CITY
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State | UT
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Zip | 84032-1391
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Country | US
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Telephone | 801-787-6209
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 59270384405
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License Number State | UT
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