Provider Demographics
NPI:1871584375
Name:MCKNIGHT, DOUGLAS J (PA-C)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HHC 2X UNIT #15077 BOX 703
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224
Mailing Address - Country:US
Mailing Address - Phone:011-339-6059
Mailing Address - Fax:
Practice Address - Street 1:HHC 2X UNIT #15077 BOX 703
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224
Practice Address - Country:US
Practice Address - Phone:011-339-6059
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPAO1952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical