Provider Demographics
NPI:1205809118
Name:MCMAHON, KEVIN EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDWARD
Last Name:MCMAHON
Suffix:
Gender:M
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 1:2660 TATE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1465
Mailing Address - Country:US
Mailing Address - Phone:828-261-0009
Mailing Address - Fax:
Practice Address - Street 1:2660 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1465
Practice Address - Country:US
Practice Address - Phone:828-261-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103167363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP18016Medicare UPIN
NC2752894Medicare PIN