Provider Demographics
NPI:1912666710
Name:KNIGHT, ANGELICA (ACSM EP-C, CD (BAI))
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:ACSM EP-C, CD (BAI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SHORE LAKE DR APT F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1473
Mailing Address - Country:US
Mailing Address - Phone:336-346-7092
Mailing Address - Fax:
Practice Address - Street 1:125 SHORE LAKE DR APT F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1473
Practice Address - Country:US
Practice Address - Phone:336-346-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 174H00000X
NC144469AK374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty