Healthcare Provider Details

I. General information

NPI: 1699762203
Provider Name (Legal Business Name): MICHELLE P MCKNIGHT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE PENNINGTON LILES PA

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD STE 310
KNOXVILLE TN
37923-4203
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-5263
  • Fax: 865-588-3740
Mailing address:
  • Phone: 865-306-5675
  • Fax: 865-584-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1812
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1812
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: