Provider Demographics
NPI:1588625610
Name:KNOTT, CRAIG LESLIE (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:LESLIE
Last Name:KNOTT
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 POPLAR SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-3600
Mailing Address - Country:US
Mailing Address - Phone:757-761-7760
Mailing Address - Fax:
Practice Address - Street 1:1290 HERCULES AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2749
Practice Address - Country:US
Practice Address - Phone:757-761-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004130363A00000X
WAPA10004059363A00000X
AK130569363A00000X
MTMED-PAC-LIC-65937363A00000X
TXPA12113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant