Provider Demographics
NPI:1043549157
Name:KNIGHTON, SEAN ELLIOTT (APRN)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ELLIOTT
Last Name:KNIGHTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PETERSEN PKWY
Mailing Address - Street 2:
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127-9755
Mailing Address - Country:US
Mailing Address - Phone:307-883-5852
Mailing Address - Fax:307-883-4436
Practice Address - Street 1:122 PETERSEN PKWY
Practice Address - Street 2:
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127-9755
Practice Address - Country:US
Practice Address - Phone:307-883-5852
Practice Address - Fax:866-972-4881
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY35387163W00000X
NMCNP-01598363LF0000X
MTAPRN-100730363LF0000X
WY1391363LF0000X
MT34619363LF0000X
WY35387.1391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1043549157Medicaid
WY139880600Medicaid