Provider Demographics
NPI:1518119361
Name:KIGHT, MICHAEL DREW (P,A)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DREW
Last Name:KIGHT
Suffix:
Gender:M
Credentials:P,A
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 61148
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-1148
Mailing Address - Country:US
Mailing Address - Phone:904-400-6100
Mailing Address - Fax:904-400-6102
Practice Address - Street 1:1201 MONUMENT RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7411
Practice Address - Country:US
Practice Address - Phone:904-727-5151
Practice Address - Fax:904-727-3887
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003216700Medicaid
FLER104ZMedicare PIN