Provider Demographics
NPI:1760158661
Name:KNIGHT, ANDREW MARTIN
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 STATE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3984
Mailing Address - Country:US
Mailing Address - Phone:360-943-0780
Mailing Address - Fax:888-977-1564
Practice Address - Street 1:711 STATE AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3984
Practice Address - Country:US
Practice Address - Phone:360-943-0780
Practice Address - Fax:888-977-1564
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
WACG61354397390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program