Basic Information
| Provider Information | |||||||||
| NPI: | 1730161399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKAY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2377 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832062377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082327862 | ||||||||
| FaxNumber: | 2082327869 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 N MAIN | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083974126 | ||||||||
| FaxNumber: | 2083974176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA012379 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA667 | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PAF33 | 01 | ID | BLUE CROSS-LAVA | OTHER | PAF35 | 01 | ID | BLUE CROSS-POCATELLO | OTHER | 000010160947 | 01 | ID | BLUE SHIELD-DOWNEY | OTHER | 000010160949 | 01 | ID | BLUE SHIELD-MCCAMMON | OTHER | 000010160950 | 01 | ID | BLUE SHIELD-POCATELLO | OTHER | PAF30 | 01 | ID | BLUE CROSS-ABERDEEN | OTHER | 000010160948 | 01 | ID | BLUE SHIELD-LAVA | OTHER | PAF31 | 01 | ID | BLUE CROSS-AMERICAN FALLS | OTHER | 000010160946 | 01 | ID | BLUE SHIELD-ABERDEEN | OTHER | PAF32 | 01 | ID | BLUE CROSS-DOWNEY | OTHER | 000010160945 | 01 | ID | BLUE SHIELD-AMERICAN FALL | OTHER | PAF34 | 01 | ID | BLUE CROSS-MCCAMMON | OTHER |