Provider Demographics
NPI:1710063557
Name:O'CONNOR, KEVIN FRANCIS JR (P A)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
Last Name:O'CONNOR
Suffix:JR
Gender:M
Credentials:P A
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Other - Credentials:
Mailing Address - Street 1:113 COPSE WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 US COAST GUARD TRAINING CENTER
Practice Address - Street 2:TRACEN YORKTOWN CLINIC
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23690
Practice Address - Country:US
Practice Address - Phone:757-856-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22068OtherPHYSICIAN ASSISTANT
VA01100005505OtherLICENSE TO PRACTICE AS A PHYSICIAN ASSISTANT
VA01100005505OtherLICENSE TO PRACTICE AS A PHYSICIAN ASSISTANT