Provider Demographics
NPI:1962912717
Name:KNOWLES, KRISTEN ANTOINETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANTOINETTE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL RD STE 303
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4044
Mailing Address - Country:US
Mailing Address - Phone:410-414-6559
Mailing Address - Fax:
Practice Address - Street 1:110 HOSPITAL RD STE 303
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:516-655-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1050180363LA2200X
NYF308467-1363LA2200X
MDR232674363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health