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General NPI Number Information
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NPI Number | 1043027246
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Entity Type | Individual
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Provider Name | WILLIE MCKNIGHT
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Gender | Male
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1003 PARK ST
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City | OGDENSBURG
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State | NY
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Zip | 13669-3911
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Country | US
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Telephone | 518-651-2302
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Fax | 315-713-9330
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Provider Business Mailing Address
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Address Line | 324 COUNTY ROUTE 51 BLDG 1
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City | MALONE
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State | NY
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Zip | 12953-4502
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Country | US
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Telephone | 518-483-1251
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Fax | 518-483-2242
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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