Healthcare Provider Details

I. General information

NPI: 1154308682
Provider Name (Legal Business Name): RODNEY DALE KNIGHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 GORMAN AVE
ELKINS WV
26241-3181
US

IV. Provider business mailing address

812 GORMAN AVE
ELKINS WV
26241-3181
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-3300
  • Fax: 304-637-3435
Mailing address:
  • Phone: 304-636-3300
  • Fax: 304-637-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30321
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number38087
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: