Provider Demographics
NPI:1124190475
Name:KNOWLES, MALINDA KAY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:KAY
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:KAY
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2410 SONOMA ST
Mailing Address - Street 2:STE 1
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3029
Mailing Address - Country:US
Mailing Address - Phone:530-243-3339
Mailing Address - Fax:530-243-3582
Practice Address - Street 1:2410 SONOMA ST
Practice Address - Street 2:STE 1
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3029
Practice Address - Country:US
Practice Address - Phone:530-243-3339
Practice Address - Fax:530-243-3582
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF13736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079250Medicaid
CAZZZ44371ZMedicare PIN
CAGR0079250Medicaid