Individual
KENNETH E MCCOLLEY
Active
Individual
KENNETH E MCCOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110-840685
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110840685
BOARD OF MEDICINE
VA
Enumeration date
08/02/2005
Last updated
02/19/2025
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