Provider Demographics
NPI:1639813223
Name:BOUKNIGHT, ROBERT LUCAS
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LUCAS
Last Name:BOUKNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2924
Mailing Address - Country:US
Mailing Address - Phone:336-944-2652
Mailing Address - Fax:
Practice Address - Street 1:219 VANCE ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2924
Practice Address - Country:US
Practice Address - Phone:336-944-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program