Provider Demographics
NPI:1851615207
Name:KNIGHTON, JESSIE RAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:RAY
Last Name:KNIGHTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1831
Mailing Address - Country:US
Mailing Address - Phone:607-661-4459
Mailing Address - Fax:
Practice Address - Street 1:167 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1831
Practice Address - Country:US
Practice Address - Phone:607-661-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse