Provider Demographics
NPI:1255065405
Name:KNIGHT, JARED BRANDON
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:BRANDON
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 WOOD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25515-6567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7451 WOOD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25515-6567
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant