Provider Demographics
NPI:1285199869
Name:KNIGHTON, JASON (NP-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KNIGHTON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3189 N BANNOCK HWY
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3806
Mailing Address - Country:US
Mailing Address - Phone:208-220-3516
Mailing Address - Fax:
Practice Address - Street 1:2928 MICHELLE ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-8031
Practice Address - Country:US
Practice Address - Phone:208-244-0997
Practice Address - Fax:208-561-6902
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily