Provider Demographics
NPI:1700197076
Name:ALLCORN, MCKAILA (DO)
Entity Type:Individual
Prefix:
First Name:MCKAILA
Middle Name:
Last Name:ALLCORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MCKAILA
Other - Middle Name:
Other - Last Name:KLUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3043 NE 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4518
Mailing Address - Country:US
Mailing Address - Phone:541-996-7118
Mailing Address - Fax:541-996-7378
Practice Address - Street 1:3043 NE 28TH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4518
Practice Address - Country:US
Practice Address - Phone:541-996-7118
Practice Address - Fax:541-996-7378
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO750207P00000X
ORDO166602207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine