Provider Demographics
NPI:1730161399
Name:MCKAY, DEBRA S (PA-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:MCKAY
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:PO BOX 2377
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2377
Mailing Address - Country:US
Mailing Address - Phone:208-232-7862
Mailing Address - Fax:208-232-7869
Practice Address - Street 1:306 N MAIN
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:ID
Practice Address - Zip Code:83210
Practice Address - Country:US
Practice Address - Phone:208-397-4126
Practice Address - Fax:208-397-4176
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA012379363AM0700X
IDPA667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPAF33OtherBLUE CROSS-LAVA
IDPAF35OtherBLUE CROSS-POCATELLO
ID000010160947OtherBLUE SHIELD-DOWNEY
ID000010160949OtherBLUE SHIELD-MCCAMMON
ID000010160950OtherBLUE SHIELD-POCATELLO
IDPAF30OtherBLUE CROSS-ABERDEEN
ID000010160948OtherBLUE SHIELD-LAVA
IDPAF31OtherBLUE CROSS-AMERICAN FALLS
ID000010160946OtherBLUE SHIELD-ABERDEEN
IDPAF32OtherBLUE CROSS-DOWNEY
ID000010160945OtherBLUE SHIELD-AMERICAN FALL
IDPAF34OtherBLUE CROSS-MCCAMMON
IDPAF34OtherBLUE CROSS-MCCAMMON
ID16683061Medicare PIN
ID000010160948OtherBLUE SHIELD-LAVA
ID16683063Medicare PIN
IDPAF33OtherBLUE CROSS-LAVA
IDPAF31OtherBLUE CROSS-AMERICAN FALLS