Provider Demographics
NPI:1063105120
Name:KNUPP, DEVON T (FNP)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:T
Last Name:KNUPP
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 WINDSOR CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2014
Mailing Address - Country:US
Mailing Address - Phone:636-692-3012
Mailing Address - Fax:
Practice Address - Street 1:10426 BAUR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1905
Practice Address - Country:US
Practice Address - Phone:314-925-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023024713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily