Provider Demographics
NPI:1952732406
Name:MCKENNA, MARCUS A (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:A
Last Name:MCKENNA
Suffix:
Gender:M
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 1:4505 NW FIELDING RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2651
Mailing Address - Country:US
Mailing Address - Phone:785-270-0080
Mailing Address - Fax:
Practice Address - Street 1:4505 NW FIELDING RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2651
Practice Address - Country:US
Practice Address - Phone:785-270-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110918026Medicare PIN
KSKA2500017Medicare PIN