Nicole Rose Knisley, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601006025 Issued in MI

Practice address

1600 S Canton Center Rd
#140
Canton, MI 48188-1992

Phone

(734) 398-7561

Fax

(734) 398-7566

NPI assigned

Jun 27, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Epmg of Michigan, P.C.

  • Emergency Medicine Physician
  • Livonia, MI
  • NPI 1386688992
  Medicare reassignment
• St Joseph Mercy Hospital

  • Otolaryngology Physician
  • Ypsilanti, MI
  • NPI 1659499705
  Medicare reassignment
• St Joseph Mercy Hospital

  • Cardiac Rehabilitation Clinic/Center
  • Ypsilanti, MI
  • NPI 1902359094
  NPD
• Seton Health Corporation of Southeastern Michigan

  • Physical Therapy Clinic/Center
  • Macomb, MI
  • NPI 1487067260
  NPD (past)

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406505600000",
    "number": "1194011320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S CANTON CENTER RD",
            "address_2": "#140",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481881992",
            "telephone_number": "734-398-7561",
            "fax_number": "734-398-7566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S CANTON CENTER RD",
            "address_2": "#140",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481881992",
            "telephone_number": "734-398-7561",
            "fax_number": "734-398-7566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNISLEY",
        "first_name": "NICOLE",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-27",
        "last_updated": "2014-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601006025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Rose Kloss, D.O.
• Jessica Klotz, LMSW CAADC
• KM Chiropractic, LLC
• Sarah Knapp, OT
• John Lloyd Knight
• Darlenda Knuckles, LPN
• Mohammad Kobaia
• Keith Andrew Kobet, M.D.
• Laura Kobylczyk
• Mary Ann Koenig, PT

• Medical Physician Assistant in Canton, MI
• Providers in Canton, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; 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.