Provider Demographics
NPI:1326074238
Name:MCKAY, BRUCE EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:MCKAY
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 1:4111 WENDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-6831
Mailing Address - Country:US
Mailing Address - Phone:919-365-8484
Mailing Address - Fax:919-365-8450
Practice Address - Street 1:4111 WENDELL BLVD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-6831
Practice Address - Country:US
Practice Address - Phone:919-365-8484
Practice Address - Fax:919-365-8450
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10-00068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290159500Medicaid
FLE0272Medicare ID - Type Unspecified
FLS50609Medicare UPIN