Provider Demographics
NPI:1821811266
Name:MCGEORGE, KAYLA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:MCGEORGE
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 1:6560 E CALLE DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4206
Mailing Address - Country:US
Mailing Address - Phone:714-615-3463
Mailing Address - Fax:
Practice Address - Street 1:6560 E CALLE DEL NORTE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4206
Practice Address - Country:US
Practice Address - Phone:714-615-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant