MEDICARE: JENNIFER FAITH KNOWLES CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CP000613	SD

General Provider Information

NPI Number	:	1063729853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FAITH KNOWLES CNP

Provider Business Mailing Address
First Line	:	PO BOX 6020
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57709-6020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 5TH ST
Second Line	:	SUITE 107
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6014
Country	:	US
Telephone Number	:	605-342-3280
Fax Number	:	605-721-8408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	12/10/2015

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