Basic Information
| Provider Information | |||||||||
| NPI: | 1750630364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 BAYPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | SEABROOK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775861566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814744042 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7645 GILBERT STREET | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713367133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184359205 | ||||||||
| FaxNumber: | 3184359206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2012 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP136950 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP07010 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2318497 | 05 | LA | MEDICAID | 932276 | 01 | LA | MEDICARE | OTHER | 12499252 | 01 | CAQH | OTHER |