Provider Demographics
NPI:1265982417
Name:KNOWLES, KELVIN (FNP-C)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5708
Mailing Address - Country:US
Mailing Address - Phone:601-693-0118
Mailing Address - Fax:601-965-0324
Practice Address - Street 1:2701 DAVIS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5708
Practice Address - Country:US
Practice Address - Phone:601-693-0118
Practice Address - Fax:601-965-0324
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily