Healthcare Provider Details

I. General information

NPI: 1912128125
Provider Name (Legal Business Name): KARI NATASHA MCKNIGHT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N HIGHWAY 25 W SUITE 100
WILLIAMSBURG KY
40769-1576
US

IV. Provider business mailing address

PO BOX 247
JELLICO TN
37762-0247
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-2933
  • Fax: 606-549-3036
Mailing address:
  • Phone: 606-549-2933
  • Fax: 606-549-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1888
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: