Basic Information
Provider Information | |||||||||
NPI: | 1497766794 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KNOTT | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | R.N. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1012 N CARLISLE ST | ||||||||
Address2: |   | ||||||||
City: | ALBERTVILLE | ||||||||
State: | AL | ||||||||
PostalCode: | 359513853 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2568917561 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2409 HOMER CLAYTON DR | ||||||||
Address2: |   | ||||||||
City: | GUNTERSVILLE | ||||||||
State: | AL | ||||||||
PostalCode: | 359762207 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565823203 | ||||||||
FaxNumber: | 2565823216 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/11/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-102431 | AL | X |   | Nursing Service Providers | Registered Nurse |   | 163WP0808X | 1-102431 | AL | X |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0809X | 1-102431 | AL | X |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 163WP0807X | 1-102431 | AL | X |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 163WA0400X | 1-102431 | AL | X |   | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
ID Information
ID | Type | State | Issuer | Description | 51529541 | 01 | AL | BCBS | OTHER | 630638946001 | 01 | AL | CHAMPUS/TRICARE | OTHER |