Provider Demographics
NPI:1710614052
Name:KNIGHT, JEREMIAH JOSPEH (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JOSPEH
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3956 GUADALUPE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-9422
Mailing Address - Country:US
Mailing Address - Phone:559-676-3056
Mailing Address - Fax:
Practice Address - Street 1:3956 GUADALUPE CREEK RD
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9422
Practice Address - Country:US
Practice Address - Phone:559-676-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289617164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse