Provider Demographics
NPI:1063607778
Name:KNIGHT, KRISTINA (APNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2965
Mailing Address - Country:US
Mailing Address - Phone:800-246-5743
Mailing Address - Fax:715-675-5475
Practice Address - Street 1:719 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2965
Practice Address - Country:US
Practice Address - Phone:800-246-5743
Practice Address - Fax:715-675-5475
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001792363LW0102X
WI3270033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P88976Medicare UPIN