Provider Demographics
NPI:1972345031
Name:KNIGHT, MARK S (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:APRN, PMHNP
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 550
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66770-0550
Mailing Address - Country:US
Mailing Address - Phone:620-848-2300
Mailing Address - Fax:
Practice Address - Street 1:6610 SE QUAKERVALE RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:KS
Practice Address - Zip Code:66770-4185
Practice Address - Country:US
Practice Address - Phone:620-848-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS83110363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health