MEDICARE: MASON MCKNIGHT FNP-C

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	210443	LA

General Provider Information

NPI Number	:	1629867262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON MCKNIGHT FNP-C

Provider Business Mailing Address
First Line	:	8540 SIEGEN LN STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2372
Country	:	US
Telephone Number	:	225-244-8690
Fax Number	:	225-615-7704

Provider Business Practice Location Address
First Line	:	8540 SIEGEN LN STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2372
Country	:	US
Telephone Number	:	225-224-8690
Fax Number	:	225-615-7704

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

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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