Knackstedt Medical Group Inc.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

KNACKSTEDT MEDICAL GROUP INC.

Practice address

7218 4TH St NW
Los Ranchos, NM 87107-6624

Phone

(505) 730-5603

Fax

(505) 554-2313

NPI assigned

Mar 17, 2016

Last updated

Mar 17, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shirley Knackstedt, CNPNPI 1114908761

Title

Co-Owner

Phone

(505) 730-5603

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shirley Knackstedt, CFNP

  • Family Nurse Practitioner
  • Los Ranchos, NM
  • NPI 1114908761
  Authorized official Same address or phone
• Anna E Knackstedt, P.A.

  • Medical Physician Assistant
  • Albuquerque, NM
  • NPI 1821424219
  NPD (past)

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1841651809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7218 4TH ST NW",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871076624",
            "telephone_number": "505-730-5603",
            "fax_number": "505-554-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7218 4TH ST NW",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871076624",
            "telephone_number": "505-730-5603",
            "fax_number": "505-554-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNACKSTEDT MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "KNACKSTEDT",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "505-730-5603",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• K-Drugs Inc (Pharmacy Plus - Albuquerque)
• Kidsbridge
• Kidsbridge Occupational Therapy
• Jocelyn Kim, PHARMD
• Shannon King, ADN
• Shirley Knackstedt, CFNP
• Sedona Kolchinsky
• Jacob Kualapai, RDH, CDHC
• Charlotte Latham, PTA
• Virginia Marie Lawlor, B.A. C.P.R.P.

• Family Nurse Practitioner in Los Ranchos, NM
• Providers in Los Ranchos, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.