Healthcare Provider Details

I. General information

NPI: 1073216099
Provider Name (Legal Business Name): BROOKE NASH MCKNIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE
MEMPHIS TN
38103-3438
US

IV. Provider business mailing address

920 MADISON AVE
MEMPHIS TN
38103-3438
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-8489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number37407
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37407
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: