Provider Demographics
NPI:1336121656
Name:MCKAY, KATRINA WHITE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:WHITE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:ELIZABETH
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 741221
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1221
Mailing Address - Country:US
Mailing Address - Phone:803-641-5651
Mailing Address - Fax:803-641-5625
Practice Address - Street 1:302 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6302
Practice Address - Country:US
Practice Address - Phone:803-641-5000
Practice Address - Fax:803-641-5625
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004131363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0309PAMedicaid
GA143771834AMedicaid
SC0309PAMedicaid
GA143771834AMedicaid
97WCGQBMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE