Provider Demographics
NPI:1467293241
Name:MCKNIGHT, KODY WAYNE
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:WAYNE
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 1:17375 N 115TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-4511
Mailing Address - Country:US
Mailing Address - Phone:918-697-3301
Mailing Address - Fax:
Practice Address - Street 1:17375 N 115TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-4511
Practice Address - Country:US
Practice Address - Phone:918-697-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator