MEDICARE: ALISA ANAIS MCKNIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95025867	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	279045	AZ

General Provider Information

NPI Number	:	1265117857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA ANAIS MCKNIGHT

Provider Business Mailing Address
First Line	:	1298 HEARTLAND DR
Second Line	:
City	:	MANTECA
State	:	CA
Zip	:	95337-8069
Country	:	US
Telephone Number	:	209-470-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 W SHAW AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	209-429-1273
Fax Number	:	559-558-4051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	03/09/2026

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