Provider Demographics
NPI:1598773343
Name:MCKNIGHT, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:MD
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 966
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-0966
Mailing Address - Country:US
Mailing Address - Phone:252-723-1369
Mailing Address - Fax:252-773-0110
Practice Address - Street 1:320 SALTER PATH RD # UNITSAB
Practice Address - Street 2:
Practice Address - City:PINE KNOLL SHORES
Practice Address - State:NC
Practice Address - Zip Code:28512-6135
Practice Address - Country:US
Practice Address - Phone:252-773-0068
Practice Address - Fax:252-773-0110
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38137207R00000X, 207RA0401X, 208100000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC57265OtherBC BS
NC1598773343Medicaid
NCE75939Medicare UPIN
NC57265OtherBC BS
E75939Medicare UPIN