Provider Demographics
NPI:1154650133
Name:MCCALLISTER, KA YIN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KA
Middle Name:YIN
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 WINDING LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5650
Mailing Address - Country:US
Mailing Address - Phone:407-365-9648
Mailing Address - Fax:
Practice Address - Street 1:1410 W BROADWAY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6456
Practice Address - Country:US
Practice Address - Phone:407-977-1135
Practice Address - Fax:407-977-9946
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9220549363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics