Provider Demographics
NPI:1548257629
Name:KNECHT, CYNTHIA L (CRNA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:KNECHT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-1308
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:STE 5B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00013859OtherNHC CARE ADMINISTRATORS
TN0100OtherJOHN DEER
118592OtherANTHEM BCBS
TN3628973Medicaid
TN314811OtherBLUE CROSS BLUE SHIELD OF
KY74001645Medicaid
VA8901180Medicaid
TN0100OtherJOHN DEER