Provider Demographics
NPI:1760255665
Name:KNOWLES, MISTY CHRISTINE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:CHRISTINE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585-3027
Mailing Address - Country:US
Mailing Address - Phone:931-946-7768
Mailing Address - Fax:
Practice Address - Street 1:1507 MACK FLOYD RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2819
Practice Address - Country:US
Practice Address - Phone:931-808-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN128940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse