MEDICARE: KAITLIN E KNIGHT PA

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	363AS0400X	Surgical Physician Assistant	4805	OK

General Provider Information

NPI Number	:	1558090704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN E KNIGHT PA

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD STE 621
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD STE 621
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8365
Country	:	US
Telephone Number	:	405-749-4231
Fax Number	:

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

Provider Enumeration Date	:	06/05/2022
Last Update Date	:	07/26/2022

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Directions to “ KAITLIN E KNIGHT PA” Practice Location

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