Provider Demographics
NPI:1558507897
Name:KNIGHT, MACY EDINGTON (PA)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:EDINGTON
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2005 HIGHWAY 183 N
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2188
Mailing Address - Country:US
Mailing Address - Phone:325-643-3010
Mailing Address - Fax:325-643-1063
Practice Address - Street 1:2005 HIGHWAY 183 N
Practice Address - Street 2:
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2188
Practice Address - Country:US
Practice Address - Phone:325-643-3010
Practice Address - Fax:325-643-1063
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant