Provider Demographics
NPI:1215538913
Name:MCKENNA, DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:M
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 1:1 ROCKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1664
Mailing Address - Country:US
Mailing Address - Phone:814-355-4874
Mailing Address - Fax:
Practice Address - Street 1:109 CARTER PARK DR STE 3A
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1152
Practice Address - Country:US
Practice Address - Phone:864-885-0058
Practice Address - Fax:864-885-0098
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005306363A00000X
PAMA061707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant