Healthcare Provider Details

I. General information

NPI: 1568280261
Provider Name (Legal Business Name): KYLIE CHRISTINE MCKNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 JOT EM DOWN RD
CUMMING GA
30041-3406
US

IV. Provider business mailing address

3120 QUEENSGATE WAY
MOUNT PLEASANT SC
29466-9061
US

V. Phone/Fax

Practice location:
  • Phone: 770-464-6268
  • Fax:
Mailing address:
  • Phone: 770-843-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75218
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA002868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: