Provider Demographics
NPI:1558887703
Name:KNIGHT, TABITHA ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:ANN
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2925
Mailing Address - Country:US
Mailing Address - Phone:859-278-1316
Mailing Address - Fax:859-276-3847
Practice Address - Street 1:2401 PARTERRE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1686
Practice Address - Country:US
Practice Address - Phone:859-227-8656
Practice Address - Fax:859-523-8656
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011660363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100497880Medicaid