Provider Demographics
NPI:1043857311
Name:KNIBBS, NICHOLAS (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KNIBBS
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-865-6541
Mailing Address - Fax:607-865-9164
Practice Address - Street 1:130 NORTH ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1218
Practice Address - Country:US
Practice Address - Phone:607-865-6541
Practice Address - Fax:607-865-9164
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346201363LF0000X
NY737541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse