Provider Demographics
NPI:1700172897
Name:KNIGHT, DARLENE ELISE (PA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:ELISE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12200 WARWICK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-5100
Practice Address - Fax:757-534-5395
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2012-12-21
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Provider Licenses
StateLicense IDTaxonomies
GA004690363AM0700X
VA0110003971363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700172897Medicaid
VAVV7687AMedicare PIN
VA1700172897Medicaid