1730275462 NPI number — LESLY S KNOWLTON CFNP

Table of content: LESLY S KNOWLTON CFNP (NPI 1730275462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730275462 NPI number — LESLY S KNOWLTON CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOWLTON
Provider First Name:
LESLY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730275462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 GARFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-3247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-865-3600
Provider Business Mailing Address Fax Number:
304-865-3700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BELPRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45714-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-315-5709
Provider Business Practice Location Address Fax Number:
304-865-3700
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  COA NP-08402 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000699823 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3810011090 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000566952 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2645310 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00762198 . This is a "RRMCR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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