Provider Demographics
NPI:1063276277
Name:MCCRORY, KAYLA LILLIAN (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LILLIAN
Last Name:MCCRORY
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 1:100 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9372
Mailing Address - Country:US
Mailing Address - Phone:662-205-4762
Mailing Address - Fax:
Practice Address - Street 1:100 NORMAN RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9372
Practice Address - Country:US
Practice Address - Phone:662-205-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00773363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical