Provider Demographics
NPI:1659092526
Name:MARSH, MAKAILA (PA-C)
Entity Type:Individual
Prefix:
First Name:MAKAILA
Middle Name:
Last Name:MARSH
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 1:160 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-4320
Mailing Address - Country:US
Mailing Address - Phone:304-820-5252
Mailing Address - Fax:
Practice Address - Street 1:2520 TRIMMIER RD STE 100
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1945
Practice Address - Country:US
Practice Address - Phone:254-390-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE