Individual
MRS. JACQUELINE MCSALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-08914
NC
363A00000X
Physician Assistant
7737-023
WI
363AS0400X
Surgical Physician Assistant
Primary
6876
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100274093
—
WI
01
—
110-622-459
AMERICAN ACADEMY OF PAS (AAPA)
—
01
—
1159850
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
—
Enumeration date
03/03/2019
Last updated
10/07/2025
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