Provider Demographics
NPI:1558032193
Name:KNIGHT, MARK A (RN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-2275
Mailing Address - Country:US
Mailing Address - Phone:205-517-7752
Mailing Address - Fax:
Practice Address - Street 1:7363 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:DORA
Practice Address - State:AL
Practice Address - Zip Code:35062-2275
Practice Address - Country:US
Practice Address - Phone:205-517-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-179505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse