Provider Demographics
NPI:1336500784
Name:KNIGHT, CAROL M (FNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 INTERLAKE PASS
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8057
Mailing Address - Country:US
Mailing Address - Phone:914-325-7488
Mailing Address - Fax:
Practice Address - Street 1:360 INTERLAKE PASS
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8057
Practice Address - Country:US
Practice Address - Phone:914-325-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily