Misty Knight, IDC

Individual provider Active NPI Independent Duty Corpsman · Richland, NC

NPI 1215201900 · NPPES record last updated Feb 28, 2012

Key facts

NPI
1215201900
Entity type
Individual (NPI type 1)
Primary specialty
Independent Duty Corpsman 1710I1002X
Practice address
101 Gobbler Way
Richland, NC 28574
Phone
(910) 548-2259
NPI assigned
Feb 28, 2012
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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty Corpsman 1710I1002X Yes

Addresses

Primary practice location

101 Gobbler Way
Richland, NC 28574

Mailing address

101 Gobbler Way
Richland, NC 28574
Phone (910) 548-2259

Sources for this page

Verify at the official NPI Registry.