Healthcare Provider Details

I. General information

NPI: 1043108533
Provider Name (Legal Business Name): AMANDA DAWN MCKNIGHT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CRABAPPLE LN
FAIRDALE WV
25839-1129
US

IV. Provider business mailing address

PO BOX 114
GLEN DANIEL WV
25844-0114
US

V. Phone/Fax

Practice location:
  • Phone: 681-220-9285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: