Kelly Knight

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

507183 Issued in CA

Practice address

1004 W Foothill Blvd
Upland, CA 91786-3774

Phone

(909) 206-5956

NPI assigned

Jul 24, 2023

Last updated

Apr 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vitality Ageless Center LLC

  • Multi-Specialty Clinic/Center
  • Suwanee, GA
  • NPI 1730657271

  CA

  Medicare reassignment NPD
• Cal Sport Physical Medicine Inc

  dba Cal Sport Physical Medicine

  • Internal Medicine Physician
  • Oakdale, CA
  • NPI 1952868218
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1043990146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 VISTA TRUCHA",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603519",
            "telephone_number": "909-644-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 W FOOTHILL BLVD",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863774",
            "telephone_number": "909-206-5956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNIGHT",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95028325",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "507183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• King Speech Therapy Services PC
• Edna Lee King, NURSE PRACTITIONER
• Julie Anne King, M.D.
• Kinsmen LLC
• Morgan Kirk
• Alexander Knipper
• Ko and Nam DDS a Professional Dental Corporation
• Yohan Ko, L.AC
• Judith A. Koerner, LMFT
• Morris Kokhab, M.D.

• Registered Nurse in Upland, CA
• Providers in Upland, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.