Provider Demographics
NPI:1669846200
Name:O'NEIL, KATHRYN CAROL (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CAROL
Last Name:O'NEIL
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 1:3302 S NEW HOPE RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8317
Mailing Address - Country:US
Mailing Address - Phone:704-879-4936
Mailing Address - Fax:
Practice Address - Street 1:3302 S NEW HOPE RD STE 100B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056
Practice Address - Country:US
Practice Address - Phone:704-879-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019197363A00000X
NC0010-08373363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant