Provider Demographics
NPI:1548550577
Name:KNIGHT, SAMARA
Entity type:Individual
Prefix:
First Name:SAMARA
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 1:6320 RIVERSIDE PLAZA LN NW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1710
Mailing Address - Country:US
Mailing Address - Phone:505-843-6168
Mailing Address - Fax:505-792-1978
Practice Address - Street 1:4640 JEFFERSON LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2127
Practice Address - Country:US
Practice Address - Phone:505-843-6168
Practice Address - Fax:505-792-1978
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0979207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96027258Medicaid