Healthcare Provider Details

I. General information

NPI: 1265396873
Provider Name (Legal Business Name): MIKAYLA ALEXIS KNIGHT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 WAKE FOREST RD STE 450
RALEIGH NC
27609-7300
US

IV. Provider business mailing address

84 DECATUR DR
FUQUAY VARINA NC
27526-2904
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-1717
  • Fax:
Mailing address:
  • Phone: 276-692-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-17039
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: