Provider Demographics
NPI:1134145378
Name:KNIGHT MACHECA, MARY K (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:KNIGHT MACHECA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BJC SAINT PETERS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3386
Mailing Address - Country:US
Mailing Address - Phone:636-916-9615
Mailing Address - Fax:
Practice Address - Street 1:201 BJC SAINT PETERS DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3386
Practice Address - Country:US
Practice Address - Phone:636-916-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO087897363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health