Healthcare Provider Details

I. General information

NPI: 1417525841
Provider Name (Legal Business Name): KYLE BRANDON KNIGHT D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR
CORINTH MS
38834-9321
US

IV. Provider business mailing address

420 EVANS RD
NICEVILLE FL
32578-4504
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1000
  • Fax:
Mailing address:
  • Phone: 850-240-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1699756445
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: