Provider Demographics
NPI:1275847816
Name:KNIGHT, LEANNE (MED, LPC, BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MED, LPC, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 AIRPORT RD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8897
Mailing Address - Country:US
Mailing Address - Phone:769-233-8239
Mailing Address - Fax:769-233-7865
Practice Address - Street 1:1307 AIRPORT RD N
Practice Address - Street 2:SUITE B
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8897
Practice Address - Country:US
Practice Address - Phone:769-233-8239
Practice Address - Fax:769-233-7865
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1174101YP2500X
MSR883646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional