Provider Demographics
NPI:1194198945
Name:MCMAHON, KAY (PA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3441
Mailing Address - Country:US
Mailing Address - Phone:970-248-5880
Mailing Address - Fax:970-241-1112
Practice Address - Street 1:735 WHITE AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3441
Practice Address - Country:US
Practice Address - Phone:970-248-5880
Practice Address - Fax:970-241-1112
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004442363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
460846ZMFLMedicare PIN