Provider Demographics
NPI:1205366309
Name:CONNELL, KAYLA CHECKOVICH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:CHECKOVICH
Last Name:CONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:A
Other - Last Name:CHECKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:919-234-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07267363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical