Provider Demographics
NPI:1235417197
Name:KNOP, DEBRA (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KNOP
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 3160
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85117-4115
Mailing Address - Country:US
Mailing Address - Phone:480-983-0065
Mailing Address - Fax:480-671-4541
Practice Address - Street 1:625 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-5501
Practice Address - Country:US
Practice Address - Phone:480-983-0065
Practice Address - Fax:480-671-4541
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4170364SP0809X
NE02898363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ629240Medicaid
AZZ147487Medicare PIN
AZ629240Medicaid
AZZ147488Medicare PIN