MEDICARE: MICHAEL KNOTTS MSN, 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	901568	MS

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	:	1912359415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KNOTTS MSN, NP-C

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-497-7576
Fax Number	:	228-497-8869

Provider Business Practice Location Address
First Line	:	7001 HIGHWAY 614
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-6483
Country	:	US
Telephone Number	:	228-588-6622
Fax Number	:	228-588-9399

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	08/24/2020

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