Provider Demographics
NPI:1265030290
Name:MCKNIGHT, GRACE (PA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5329
Mailing Address - Country:US
Mailing Address - Phone:302-559-5352
Mailing Address - Fax:
Practice Address - Street 1:114 SANDHILL DR STE 101
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5805
Practice Address - Country:US
Practice Address - Phone:302-378-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant