Provider Demographics
NPI:1821174301
Name:KNIGHT, DAVID M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 SCHWARZ MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6710
Mailing Address - Country:US
Mailing Address - Phone:618-698-6299
Mailing Address - Fax:
Practice Address - Street 1:9717 LANDMARK PARKWAY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1628
Practice Address - Country:US
Practice Address - Phone:314-849-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140253103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2215445OtherBC/BS ILLINOIS
MO126861OtherBC/BS MISSOURI