Provider Demographics
NPI:1316729742
Name:KNIGHT, JERAD H (FNP-C)
Entity type:Individual
Prefix:
First Name:JERAD
Middle Name:H
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 ROCKY RD
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-3330
Mailing Address - Country:US
Mailing Address - Phone:208-534-1702
Mailing Address - Fax:
Practice Address - Street 1:554 W SUNNYSLOPE DR
Practice Address - Street 2:
Practice Address - City:PAUL
Practice Address - State:ID
Practice Address - Zip Code:83347-8791
Practice Address - Country:US
Practice Address - Phone:208-534-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID64373163W00000X
IDTEMP64373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse