Provider Demographics
NPI:1912255415
Name:KNIGHT, JOLENE ANN (RN, PMHNP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:ANN
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-3427
Mailing Address - Country:US
Mailing Address - Phone:631-578-5080
Mailing Address - Fax:
Practice Address - Street 1:227 COMMACK RD
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-3427
Practice Address - Country:US
Practice Address - Phone:631-578-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY759874163WG0600X
NY310830-1164W00000X
NY405075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No164W00000XNursing Service ProvidersLicensed Practical Nurse