Provider Demographics
NPI:1235594235
Name:MCGILL, KARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARIE
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
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 REYNOLDS WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1586
Mailing Address - Country:US
Mailing Address - Phone:937-485-9401
Mailing Address - Fax:937-485-9412
Practice Address - Street 1:1 REYNOLDS WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45430-1586
Practice Address - Country:US
Practice Address - Phone:937-485-9401
Practice Address - Fax:937-485-9412
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant