Provider Demographics
NPI:1568244861
Name:KNIGHT, CONNIE A
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:A
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 HERONS CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5812
Mailing Address - Country:US
Mailing Address - Phone:330-270-9005
Mailing Address - Fax:
Practice Address - Street 1:6249 HERONS CIR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5812
Practice Address - Country:US
Practice Address - Phone:330-270-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker