Individual
MR. KEVIN MICHAEL KNACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
655 REDWOOD HWY FRONTAGE RD STE 240, MILL VALLEY, CA 94941-3055
(866) 247-4292
(866) 247-4292
Mailing address
655 REDWOOD HWY FRONTAGE RD STE 240, MILL VALLEY, CA 94941-3055
(866) 247-4292
(866) 247-4292
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95014679
CA
163W00000X
Registered Nurse
RN60313579
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95014679
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60313580
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2025451
—
WA
Enumeration date
10/02/2010
Last updated
09/02/2025
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