Provider Demographics
NPI:1689465791
Name:MCGONAGLE, KAITLYN NICOLE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICOLE
Last Name:MCGONAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 ALLEN JARRETT DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9522
Mailing Address - Country:US
Mailing Address - Phone:336-260-6897
Mailing Address - Fax:
Practice Address - Street 1:1780 ALLEN JARRETT DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9522
Practice Address - Country:US
Practice Address - Phone:336-260-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer