Provider Demographics
NPI:1912423237
Name:MCKNIGHT, RAKEVIA LAKEISHA (CLC)
Entity Type:Individual
Prefix:
First Name:RAKEVIA
Middle Name:LAKEISHA
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:RAKEVIA
Other - Middle Name:LAKEISHA
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC
Mailing Address - Street 1:2286 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2286 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6603
Practice Address - Country:US
Practice Address - Phone:786-312-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FLALPP-210729174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0Medicaid