Provider Demographics
NPI:1205833621
Name:KNAPIK-SMITH, MICHELE (APN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:KNAPIK-SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 VARDEN DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5285
Mailing Address - Country:US
Mailing Address - Phone:803-642-3801
Mailing Address - Fax:803-642-5538
Practice Address - Street 1:33 VARDEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5285
Practice Address - Country:US
Practice Address - Phone:803-642-3801
Practice Address - Fax:803-642-5538
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN082188364S00000X
SCAPN567364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1019Medicaid