Provider Demographics
NPI:1114651924
Name:SPILLAR, MCKENNA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:MARIE
Last Name:SPILLAR
Suffix:
Gender:F
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 1:1441 WILKINS CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1337
Mailing Address - Country:US
Mailing Address - Phone:307-233-2700
Mailing Address - Fax:
Practice Address - Street 1:1441 WILKINS CIR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1337
Practice Address - Country:US
Practice Address - Phone:307-233-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program