Provider Demographics
NPI:1659101574
Name:GAU, MCKENNA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:MICHELLE
Last Name:GAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:2545 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2839
Practice Address - Country:US
Practice Address - Phone:209-948-5940
Practice Address - Fax:209-473-9291
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant