MEDICARE: PISETH KNIGHT NP

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	54151	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063783710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PISETH KNIGHT NP

Provider Business Mailing Address
First Line	:	1111 ALAMEDA BLVD NW STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-1953
Country	:	US
Telephone Number	:	505-346-3704
Fax Number	:	505-387-3937

Provider Business Practice Location Address
First Line	:	1111 ALAMEDA BLVD NW STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-1953
Country	:	US
Telephone Number	:	505-346-3704
Fax Number	:	505-212-0859

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

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	03/23/2024

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Directions to “ PISETH KNIGHT NP” Practice Location

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