Provider Demographics
NPI:1578565453
Name:KNIGHT, NATASHA MOZELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:MOZELLE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E VALLEY RD
Mailing Address - Street 2:UNIT 105
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8304
Mailing Address - Country:US
Mailing Address - Phone:970-618-2717
Mailing Address - Fax:
Practice Address - Street 1:1450 E VALLEY RD UNIT 105
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8352
Practice Address - Country:US
Practice Address - Phone:970-927-1717
Practice Address - Fax:970-927-6164
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45757207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47206331Medicaid
FLH40464Medicare UPIN
FL259498600Medicaid