Provider Demographics
NPI:1194045187
Name:MCKISSICK, JERMAHL DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JERMAHL
Middle Name:DAVID
Last Name:MCKISSICK
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:10651 E ST
Mailing Address - Street 2:NAVAL HEALTH CLINIC CORPUS CHRISTI TX
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78419-5130
Mailing Address - Country:US
Mailing Address - Phone:559-513-1586
Mailing Address - Fax:
Practice Address - Street 1:10651 E ST
Practice Address - Street 2:NAVAL HEALTH CLINIC CORPUS CHRISTI TX
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5130
Practice Address - Country:US
Practice Address - Phone:559-513-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1091561363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical