Provider Demographics
NPI:1821368382
Name:MCGREGOR, KAYLA S (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:S
Last Name:MCGREGOR
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 1:1 NOLTE DR
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7111
Mailing Address - Country:US
Mailing Address - Phone:724-543-8759
Mailing Address - Fax:724-543-8743
Practice Address - Street 1:1 NOLTE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:724-543-8759
Practice Address - Fax:724-543-8743
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009654Medicaid