Active NPI
Michael McKnatt
- Pharmacist
- Southaven, MS
National Provider Identifier
1487024857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 8255
- Practice address
- 1235 Stateline Rd W
Southaven, MS 38671-1429 - Phone
- (187) 786-4795
- Fax
- (662) 342-9026
- NPI assigned
- Sep 29, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8255 | MS | Primary |
Addresses
Primary practice location
1235 Stateline Rd W
Southaven, MS 38671-1429
Mailing address
1235 Stateline Rd W
Southaven, MS 38671-1429
Phone (187) 786-4795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8255 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443484800000",
"number": "1487024857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 STATELINE RD W",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386711429",
"telephone_number": "187-786-4795",
"fax_number": "662-342-9026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 STATELINE RD W",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386711429",
"telephone_number": "187-786-4795",
"fax_number": "662-342-9026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKNATT",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-29",
"last_updated": "2015-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "8255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.