MEDICARE: TARYN ASHLEY MCKENNA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085008406	IL
2	363AS0400X	Surgical Physician Assistant	085008406	IL

General Provider Information

NPI Number	:	1700403813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARYN ASHLEY MCKENNA PA-C

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2000
Fax Number	:	847-570-2930

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2000
Fax Number	:	847-570-2930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	03/24/2026

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