Provider Demographics
NPI:1821248550
Name:MCKNIGHT, AARON PRESTELLE (APRN)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:PRESTELLE
Last Name:MCKNIGHT
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2631
Mailing Address - Country:US
Mailing Address - Phone:619-905-1980
Mailing Address - Fax:
Practice Address - Street 1:AUTUMN LAKE HEALTHCARE
Practice Address - Street 2:400 BRITTANY FARMS RD
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053
Practice Address - Country:US
Practice Address - Phone:619-905-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X
CT180292363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman