Provider Demographics
NPI:1720830607
Name:KNIGHT, KATELYNNE
Entity Type:Individual
Prefix:
First Name:KATELYNNE
Middle Name:
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 1:3440 SW US VETERANS HOSPITAL RD APT 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3120
Mailing Address - Country:US
Mailing Address - Phone:720-454-6081
Mailing Address - Fax:
Practice Address - Street 1:3440 SW US VETERANS HOSPITAL RD APT 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3120
Practice Address - Country:US
Practice Address - Phone:720-454-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202111471RN163W00000X
WARN61267606-163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse