Healthcare Provider Details

I. General information

NPI: 1073173514
Provider Name (Legal Business Name): FALAN NICHOLE MCKNIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 MS HIGHWAY 12
ACKERMAN MS
39735-8917
US

IV. Provider business mailing address

1665 S GREEN ST
TUPELO MS
38804-6556
US

V. Phone/Fax

Practice location:
  • Phone: 662-285-4400
  • Fax:
Mailing address:
  • Phone: 662-377-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28737
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: