Provider Demographics
NPI:1629614656
Name:KNIGHT, GENIECE FERNON
Entity Type:Individual
Prefix:
First Name:GENIECE
Middle Name:FERNON
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 1:2916 HAPPY VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-9461
Mailing Address - Country:US
Mailing Address - Phone:209-631-9739
Mailing Address - Fax:
Practice Address - Street 1:2916 HAPPY VALLEY CT
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-9461
Practice Address - Country:US
Practice Address - Phone:209-631-9739
Practice Address - Fax:209-357-4010
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider