Provider Demographics
NPI:1922394469
Name:KNIGHT STARLING, DAPHENIA C (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DAPHENIA
Middle Name:C
Last Name:KNIGHT STARLING
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AMITY LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7941
Mailing Address - Country:US
Mailing Address - Phone:601-206-0901
Mailing Address - Fax:888-240-6288
Practice Address - Street 1:CLINTON HEALTHCARE
Practice Address - Street 2:1251 PINEHAVEN RD
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056
Practice Address - Country:US
Practice Address - Phone:601-206-0901
Practice Address - Fax:888-240-6288
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR718319363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02052873Medicaid