Provider Demographics
NPI:1013348739
Name:MCKNIGHT, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MCKNIGHT
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:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:BULLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10915-0135
Mailing Address - Country:US
Mailing Address - Phone:843-957-1585
Mailing Address - Fax:
Practice Address - Street 1:2856 STATE ROUTE 17K
Practice Address - Street 2:
Practice Address - City:BULLVILLE
Practice Address - State:NY
Practice Address - Zip Code:10915-0000
Practice Address - Country:US
Practice Address - Phone:843-957-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630925-1163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management