Provider Demographics
NPI:1891063301
Name:MCKNIGHT, EBONY YVETTE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:EBONY
Middle Name:YVETTE
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR STE 140
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4731
Mailing Address - Country:US
Mailing Address - Phone:310-246-0702
Mailing Address - Fax:310-246-0672
Practice Address - Street 1:415 N CRESCENT DR STE 140
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4731
Practice Address - Country:US
Practice Address - Phone:310-246-0702
Practice Address - Fax:310-246-0672
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606430163W00000X
NY336952363LF0000X
CA21723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse