Provider Demographics
NPI:1912128125
Name:MCKNIGHT, KARI NATASHA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:NATASHA
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:PAC
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 247
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0247
Mailing Address - Country:US
Mailing Address - Phone:606-549-2933
Mailing Address - Fax:606-549-3036
Practice Address - Street 1:475 N HIGHWAY 25 W
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1576
Practice Address - Country:US
Practice Address - Phone:606-549-2933
Practice Address - Fax:606-549-3036
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1888363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCS1622500145OtherHUMANA
TNQ025009Medicaid
KY7100398340Medicaid
KY50107110OtherPASSPORT HEALTH
KY50107110OtherPASSPORT HEALTH
TNQ025009Medicaid