Provider Demographics
NPI:1659464840
Name:MCKNIGHT, ELLEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:W
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 SUMMIT BOULEVARD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-438-0044
Mailing Address - Fax:866-941-4757
Practice Address - Street 1:3298 SUMMIT BOULEVARD
Practice Address - Street 2:SUITE 9
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-438-0044
Practice Address - Fax:866-941-4757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61717207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000570600Medicaid
1215172572OtherGROUP NPI FOR ELLEN W MCKNIGHT MD PLLC
FL000570600Medicaid