Individual provider Active NPI

Kristeva Jo Knab, PA-C

  • Physician Assistant
  • Marietta, OH
National Provider Identifier
1073984829
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.004516 Issued in OH
Practice address
400 Matthew St
Suite 401
Marietta, OH 45750-1644
Phone
(740) 374-2252
Fax
(740) 374-4974
NPI assigned
Oct 19, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.004516 OH Primary

Addresses

Primary practice location

400 Matthew St
Suite 401
Marietta, OH 45750-1644

Mailing address

PO Box 449
Marietta, OH 45750-0449
Phone (740) 374-4500

Other identifiers 1

IdentifierTypeStateIssuer
0147749MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151105000496 OH Practitioner - Physician Assistant 1456661362 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.004516OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Marietta Memorial Hospital CurrentSince Oct 15, 2015 Accepting new patients

Locations

401 Matthew St
Marietta, OH 45750
Phone (740) 374-1400

701 Hildreth Ln
Marietta, OH 45750
Phone (740) 371-7194

400 Matthew St
Ste 401
Marietta, OH 45750
Phone (740) 374-2252

416 Colegate Dr
#3
Marietta, OH 45750
Phone (740) 236-9047

400 Matthew St
Ste 101
Marietta, OH 45750
Phone (740) 568-4150

Interoperability endpoints

  • Direct secure messaging: kristeva.knab@mmhs.medicity.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1445212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1073984829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 449",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457500449",
            "telephone_number": "740-374-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MATTHEW ST",
            "address_2": "SUITE 401",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501644",
            "telephone_number": "740-374-2252",
            "fax_number": "740-374-4974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNAB",
        "first_name": "KRISTEVA",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-19",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0147749",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, OH

Sources for this page

Verify at the official NPI Registry.