Basic Information
| Provider Information | |||||||||
| NPI: | 1386625408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148387912 | ||||||||
| FaxNumber: | 3149216283 | ||||||||
| Practice Location | |||||||||
| Address1: | 637 DUNN RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | HAZELWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630421759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148387912 | ||||||||
| FaxNumber: | 3149216283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | R6C42 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 24176 | 01 | MO | BCBS | OTHER | A13764 | 01 | MO | MERCY | OTHER | 171713 | 01 | MO | HEALTHLINK | OTHER | 1957V34311 | 01 | MO | HEALTHCARE USA | OTHER | 39946 | 01 | MO | GHP | OTHER | 109461 | 01 | MO | BLUE CHOICE | OTHER | 1200168 | 01 | MO | UHC | OTHER | 4202179 | 01 | MO | AENTA | OTHER |