Provider Demographics
NPI:1558958165
Name:MCKNIGHT, TANJA
Entity Type:Individual
Prefix:MS
First Name:TANJA
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12779 PACER DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8117
Mailing Address - Country:US
Mailing Address - Phone:614-323-7314
Mailing Address - Fax:614-497-1204
Practice Address - Street 1:12779 PACER DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8117
Practice Address - Country:US
Practice Address - Phone:614-323-7314
Practice Address - Fax:614-497-1204
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care