Provider Demographics
NPI:1992276679
Name:KNISELY, JENNIFER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KNISELY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E 8TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2861
Mailing Address - Country:US
Mailing Address - Phone:619-267-9257
Mailing Address - Fax:619-267-9273
Practice Address - Street 1:610 EUCLID AVE STE 200
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2951
Practice Address - Country:US
Practice Address - Phone:619-267-9257
Practice Address - Fax:619-267-9273
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2018069770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA678055OtherREGISTERED NURSE