Provider Demographics
NPI:1508964172
Name:KNIGHT, KYLER S (MD)
Entity Type:Individual
Prefix:
First Name:KYLER
Middle Name:S
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 VISTA RD
Mailing Address - Street 2:#250
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2159
Mailing Address - Country:US
Mailing Address - Phone:713-490-1188
Mailing Address - Fax:713-490-1198
Practice Address - Street 1:3801 VISTA RD
Practice Address - Street 2:#250
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2159
Practice Address - Country:US
Practice Address - Phone:713-490-1188
Practice Address - Fax:713-490-1198
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096503004Medicaid
TX096503004Medicaid