Provider Demographics
NPI:1588395396
Name:KNIGHT, ANGIE MARIE (APRN-CNP, FNP-C/BC)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
Last Name:KNIGHT
Suffix:
Gender:
Credentials:APRN-CNP, FNP-C/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 HIGHWAY 62 E UNIT 17
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3655
Mailing Address - Country:US
Mailing Address - Phone:870-706-0855
Mailing Address - Fax:
Practice Address - Street 1:165 JERRY BAKER LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-9485
Practice Address - Country:US
Practice Address - Phone:870-232-5315
Practice Address - Fax:870-232-5316
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221879363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR304620758Medicaid