Healthcare Provider Details

I. General information

NPI: 1447243316
Provider Name (Legal Business Name): MICHAEL W KNIGHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MEDICAL CENTER BLVD
FAYETTEVILLE TN
37334-2684
US

IV. Provider business mailing address

PO BOX 1429
FAYETTEVILLE TN
37334-1429
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-1100
  • Fax: 931-438-7491
Mailing address:
  • Phone: 931-438-1100
  • Fax: 931-438-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000082058
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: