Provider Demographics
NPI:1548300791
Name:KNIGHT, KATHLEEN RAMBO (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RAMBO
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 GRIFFING AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3012
Mailing Address - Country:US
Mailing Address - Phone:631-369-7080
Mailing Address - Fax:
Practice Address - Street 1:448 GRIFFING AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3012
Practice Address - Country:US
Practice Address - Phone:631-369-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3328141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S63256Medicare UPIN
NY2E4121Medicare ID - Type Unspecified