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Individual
WILLIAM A MCCULLOUGH
Active
Individual
WILLIAM A MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MCMSC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01493
KS
363A00000X
Physician Assistant
Primary
2144
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-01493
STATE OF KANSAS LICENSE
KS
Enumeration date
11/08/2011
Last updated
04/02/2015
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