Provider Demographics
NPI:1932413390
Name:KNIGHT, LEAH DIANE (CNS)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:DIANE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 S RILEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-2861
Mailing Address - Country:US
Mailing Address - Phone:317-512-6878
Mailing Address - Fax:
Practice Address - Street 1:1700 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1316
Practice Address - Country:US
Practice Address - Phone:317-931-5135
Practice Address - Fax:317-931-5113
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003300A364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult