Provider Demographics
NPI:1164446308
Name:KNIGHT, POLLY (MD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N CARTWRIGHT
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-7111
Mailing Address - Country:US
Mailing Address - Phone:903-482-9153
Mailing Address - Fax:903-482-9514
Practice Address - Street 1:350 N CARTWRIGHT
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-7111
Practice Address - Country:US
Practice Address - Phone:903-482-9153
Practice Address - Fax:903-482-9514
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103632904Medicaid
TX103632904Medicaid
TXH09510Medicare UPIN