Provider Demographics
NPI:1164496816
Name:MCKNIGHT, RODNEY LEONARD JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:LEONARD
Last Name:MCKNIGHT
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3345 SUNNINGDALE LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-7508
Mailing Address - Country:US
Mailing Address - Phone:704-924-9805
Mailing Address - Fax:704-924-8509
Practice Address - Street 1:218 OLD MOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1930
Practice Address - Country:US
Practice Address - Phone:704-873-0281
Practice Address - Fax:704-838-7261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC083028367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051249Medicaid
NC8051249Medicaid