Provider Demographics
NPI:1376156828
Name:KNAPP, KILEY R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:R
Last Name:KNAPP
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHURCH HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2093
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282-4138
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-225-2692
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MECNP201277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program