Provider Demographics
NPI:1073923231
Name:MCKNIGHT, CHARLOTTE (MD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:5100 N TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7479
Practice Address - Country:US
Practice Address - Phone:417-730-5550
Practice Address - Fax:417-730-5555
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019035481208000000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program