Provider Demographics
NPI:1841560927
Name:KNOX, ELLOUISE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:ELLOUISE
Middle Name:MARIE
Last Name:KNOX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 698
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611
Mailing Address - Country:US
Mailing Address - Phone:662-838-2163
Mailing Address - Fax:901-969-1406
Practice Address - Street 1:12 E BRUNSWICK ST
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611
Practice Address - Country:US
Practice Address - Phone:615-425-4200
Practice Address - Fax:615-425-4268
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily