1922394469 NPI number — MRS. DAPHENIA C. KNIGHT STARLING ANP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922394469 NPI number — MRS. DAPHENIA C. KNIGHT STARLING ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT STARLING
Provider First Name:
DAPHENIA
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
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:
1922394469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 AMITY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39047-7941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-206-0901
Provider Business Mailing Address Fax Number:
888-240-6288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLINTON HEALTHCARE
Provider Second Line Business Practice Location Address:
1251 PINEHAVEN RD
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-206-0901
Provider Business Practice Location Address Fax Number:
888-240-6288
Provider Enumeration Date:
06/23/2011

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: 363LA2200X , with the licence number:  R718319 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02052873 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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