Provider Demographics
NPI:1730651027
Name:MCKNIGHT JOHNSON, KASHAIRRA
Entity Type:Individual
Prefix:
First Name:KASHAIRRA
Middle Name:
Last Name:MCKNIGHT JOHNSON
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 1:1109 ORAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-1135
Mailing Address - Country:US
Mailing Address - Phone:314-255-4500
Mailing Address - Fax:
Practice Address - Street 1:1109 ORAN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-1135
Practice Address - Country:US
Practice Address - Phone:314-255-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherCOMPANIONSHIP