Provider Demographics
NPI:1881660777
Name:KNIGHT, JOHN WALTER III (PA-C)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:WALTER
Last Name:KNIGHT
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2650
Mailing Address - Country:US
Mailing Address - Phone:870-534-3349
Mailing Address - Fax:870-535-3973
Practice Address - Street 1:8 NEW MIDDLETON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:GORDONSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38563-6603
Practice Address - Country:US
Practice Address - Phone:931-472-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2509363A00000X
ARPA-732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000Medicare UPIN