Provider Demographics
NPI:1457526949
Name:KNIGHT, KIMBERLY RENEE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W 5TH AVE
Mailing Address - Street 2:#257
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2310
Mailing Address - Country:US
Mailing Address - Phone:510-303-3563
Mailing Address - Fax:
Practice Address - Street 1:1601 W 5TH AVE
Practice Address - Street 2:#257
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2310
Practice Address - Country:US
Practice Address - Phone:510-303-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program