Provider Demographics
NPI:1710147343
Name:KNIGHTEN, KELLY KILEY (AUD, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KILEY
Last Name:KNIGHTEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 MERAMEC STATION RD STE F
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-2045
Mailing Address - Country:US
Mailing Address - Phone:636-825-9999
Mailing Address - Fax:
Practice Address - Street 1:912 MERAMEC STATION RD STE F
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-2045
Practice Address - Country:US
Practice Address - Phone:636-825-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014036556231H00000X
TX51317237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter