Provider Demographics
NPI:1447243316
Name:KNIGHT, MICHAEL W (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-1429
Mailing Address - Country:US
Mailing Address - Phone:931-438-1100
Mailing Address - Fax:931-438-7491
Practice Address - Street 1:106 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2684
Practice Address - Country:US
Practice Address - Phone:931-438-1100
Practice Address - Fax:931-438-7491
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000082058163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3003793OtherBCBS TENNESSEE
TN3622566Medicaid
TN3622566Medicaid