Provider Demographics
NPI:1346778966
Name:KNIGHT, NICOLE DENISE (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DENISE
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4 BRADLEY PARK CT STE 3A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9220
Mailing Address - Country:US
Mailing Address - Phone:888-884-9493
Mailing Address - Fax:888-884-9493
Practice Address - Street 1:4 BRADLEY PARK CT STE 3A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9220
Practice Address - Country:US
Practice Address - Phone:888-884-9493
Practice Address - Fax:888-884-9493
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN197895OtherGEORGIA BOARD FAMILY NURSE PRACTITIONER
F02170297OtherNATIONAL BOARD CERTIFICATION FOR FAMILY NURSE PRACTITIONER