Provider Demographics
NPI:1154100972
Name:KNIGHT, MADISON RAYNE (TCM)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:RAYNE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11518 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1316
Mailing Address - Country:US
Mailing Address - Phone:502-445-6325
Mailing Address - Fax:
Practice Address - Street 1:11518 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1316
Practice Address - Country:US
Practice Address - Phone:502-445-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator