Provider Demographics
NPI:1417621210
Name:KNOX, KATIE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:KNOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6356 NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:WARNERS
Mailing Address - State:NY
Mailing Address - Zip Code:13164-9705
Mailing Address - Country:US
Mailing Address - Phone:315-704-4254
Mailing Address - Fax:
Practice Address - Street 1:97 PATRICIA DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4272
Practice Address - Country:US
Practice Address - Phone:315-383-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY731560-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse