Provider Demographics
NPI:1588171094
Name:MORRIS, KATHLEEN MCMAHON (PA-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MCMAHON
Last Name:MORRIS
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 1:610 JETTON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9320
Mailing Address - Country:US
Mailing Address - Phone:704-900-0487
Mailing Address - Fax:
Practice Address - Street 1:610 JETTON ST STE 210
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9320
Practice Address - Country:US
Practice Address - Phone:704-900-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant