Susan Roberta Knight

Key facts

NPI

1154818581

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

092041-1 (NY)

Practice address

1990 Jones Rd
Andover, NY 14806-9723

Phone

(607) 478-8475

NPI assigned

Apr 20, 2018

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 20, 2018.

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524182400000",
    "number": "1154818581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 JONES RD",
            "city": "ANDOVER",
            "state": "NY",
            "postal_code": "148069723",
            "telephone_number": "607-478-8475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 JONES RD",
            "city": "ANDOVER",
            "state": "NY",
            "postal_code": "148069723",
            "telephone_number": "607-478-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNIGHT",
        "first_name": "SUSAN",
        "middle_name": "ROBERTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-20",
        "last_updated": "2018-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "092041-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Andover, NY · Licensed Practical Nurse in New York