Provider Demographics
NPI:1386006120
Name:MCKNIGHT, STORMI (RN)
Entity Type:Individual
Prefix:
First Name:STORMI
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2636
Mailing Address - Country:US
Mailing Address - Phone:580-298-3351
Mailing Address - Fax:
Practice Address - Street 1:603 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2636
Practice Address - Country:US
Practice Address - Phone:580-298-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76851363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health