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NPI Code Detail

MEDICARE: DEREK SCOTT KNOKE FNP

MEDICARE: DEREK SCOTT KNOKE FNP
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
1363L00000XNurse Practitioner10021520OR

General Provider Information

NPI Number : 1811754351
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK SCOTT KNOKE FNP
Provider Business Mailing Address
First Line : 9605 GRAND RONDE RD
Second Line :
City : GRAND RONDE
State : OR
Zip : 97347-9712
Country : US
Telephone Number : 503-879-2239
Fax Number : 503-879-2071
Provider Business Practice Location Address
First Line : 9605 GRAND RONDE RD
Second Line :
City : GRAND RONDE
State : OR
Zip : 97347-9712
Country : US
Telephone Number : 503-879-2002
Fax Number : 503-879-2071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2024
Last Update Date : 02/13/2026

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Directions to “ DEREK SCOTT KNOKE FNP” Practice Location

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