Provider Demographics
NPI:1720006927
Name:CONNERY, KATHLEEN LYNN (PA-C,MPAC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LYNN
Last Name:CONNERY
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Gender:F
Credentials:PA-C,MPAC
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Mailing Address - Street 1:10823 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8937
Mailing Address - Country:US
Mailing Address - Phone:352-514-7062
Mailing Address - Fax:
Practice Address - Street 1:6420 W NEWBERRY RD
Practice Address - Street 2:EAST WING, SUITE 100
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4308
Practice Address - Country:US
Practice Address - Phone:352-332-3900
Practice Address - Fax:352-332-5009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-10-05
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292508700Medicaid
FL292508700Medicaid
FLU8888ZMedicare PIN