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Individual
MR. JOHN KELLY MCCORMICK
Active
Individual
MR. JOHN KELLY MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC316
KY
363AM0700X
Medical Physician Assistant
TC316
KY
363AS0400X
Surgical Physician Assistant
TC316
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Enumeration date
02/09/2022
Last updated
10/24/2022
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