DEIDRA CASSANDRA KNAUTH


Address: 62 Hackett Blvd Ste 4, Albany, NY 12209-1756
Phone: 5184342244

DEIDRA CASSANDRA KNAUTH (NPI# 1679139075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1679139075
Entity Type Individual
Full Name DEIDRA CASSANDRA KNAUTH
Credential FNP, RN
Practice Address 62 Hackett Blvd Ste 4
Albany
NY 12209-1756
Mailing Address 387 Madison Ave # 2f
Albany
NY 12210-1713
Practice Telephone 5184342244
Mailing Telephone 8455943136
Enumeration Date 2019-05-13
Last Update Date 2019-10-22
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 163W00000X Registered Nurse 621039 NY Nursing Service Providers
Y 363LF0000X Nurse Practitioner
Specialization: Family
F344736-01 NY Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 62 HACKETT BLVD STE 4
City ALBANY
State NY
Zip Code 12209-1756

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1205385218 Shirley Jean Bolden Licensed Practical Nurse 3 Beekman St., Albany, NY 12209 2016-10-03
1285069492 Chandra Wells Speech-Language Pathologist 33 Betwood St, Albany, NY 12209 2013-09-06
1790061406 Olive Farooq Registered Nurse 100 Elbel Ct, Albany, NY 12209 2011-10-26
1982988184 Susan Daniels Social Worker 100 Elbel Court, Myers Middle School, Albany, NY 12209 2011-10-06
1679725535 Alyssa Catharine Lotmore Social Worker 102 Hackett Blvd., Albany, NY 12209 2008-10-22
1255497707 Kimberly Ann Kilby Family Medicine 25 Hackett Blvd # Mc133, Albany, NY 12209 2006-12-29
1427158880 Eckerd Corporation Pharmacy 493 Delaware Avenue, Albany, NY 12209 2006-09-25
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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Competitor

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City ALBANY
Zip Code 12209

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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