Individual
KISHA L KNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
404 LILLIE BURNEY ST, HATTIESBURG, MS 39401-5505
(601) 450-6500
(601) 450-6503
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-3700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R863895
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05401590
—
MS
01
—
12181296
CAQH ID NUMBER
MS
01
—
9900628
AETNA
MS
Enumeration date
11/09/2010
Last updated
04/01/2014
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