Provider Demographics
NPI:1083851026
Name:KNAPP, CHARLA WURSTER (NP)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:WURSTER
Last Name:KNAPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321359
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1359
Mailing Address - Country:US
Mailing Address - Phone:601-936-1395
Mailing Address - Fax:601-933-6596
Practice Address - Street 1:315 JOHN R JUNKIN DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3823
Practice Address - Country:US
Practice Address - Phone:601-445-1715
Practice Address - Fax:601-445-6720
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS785451363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01926528Medicaid
LA1882372Medicaid
LA25083YKH4Medicare PIN