MEDICARE: LISA MAE KNOWLTON NP-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	AP9800	AZ

General Provider Information

NPI Number	:	1861938839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MAE KNOWLTON NP-C

Provider Business Mailing Address
First Line	:	4100 S LINDSAY RD BLDG 6
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-1506
Country	:	US
Telephone Number	:	602-834-0505
Fax Number	:	520-775-3990

Provider Business Practice Location Address
First Line	:	3623 CROSSINGS DR STE 206
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7101
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:

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

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	02/11/2026

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