Provider Demographics
NPI:1356301865
Name:KNIGHT, JOHN J JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:KNIGHT
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32392 WEISS RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-4907
Mailing Address - Country:US
Mailing Address - Phone:225-686-1625
Mailing Address - Fax:
Practice Address - Street 1:8742 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7915
Practice Address - Country:US
Practice Address - Phone:225-231-7070
Practice Address - Fax:225-231-7069
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CA33P400Medicare ID - Type Unspecified