Provider Demographics
NPI:1871328781
Name:KNIGHT, SAMUEL JEROME JR
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JEROME
Last Name:KNIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 PHILPOTTS RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3156
Mailing Address - Country:US
Mailing Address - Phone:757-509-4567
Mailing Address - Fax:
Practice Address - Street 1:954 PHILPOTTS RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-3156
Practice Address - Country:US
Practice Address - Phone:757-509-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA928508374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide