Provider Demographics
NPI:1578320677
Name:KEGEL, JACQUELINE SCHON (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SCHON
Last Name:KEGEL
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 1:60 IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4714
Mailing Address - Country:US
Mailing Address - Phone:203-915-3172
Mailing Address - Fax:
Practice Address - Street 1:60 IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4714
Practice Address - Country:US
Practice Address - Phone:203-915-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant