Provider Demographics
NPI:1003572397
Name:KNIGHT, JEWAL VELORE
Entity Type:Individual
Prefix:MRS
First Name:JEWAL
Middle Name:VELORE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GREENLEAF RD
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-8106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:919-205-1532
Practice Address - Street 1:3560 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9495
Practice Address - Country:US
Practice Address - Phone:919-710-9895
Practice Address - Fax:919-205-1532
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist