Provider Demographics
NPI:1215201900
Name:KNIGHT, MISTY (IDC)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GOBBLER WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28574
Mailing Address - Country:US
Mailing Address - Phone:910-548-2259
Mailing Address - Fax:
Practice Address - Street 1:101 GOBBLER WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:NC
Practice Address - Zip Code:28574
Practice Address - Country:US
Practice Address - Phone:910-548-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman