Healthcare Provider Details

I. General information

NPI: 1154042570
Provider Name (Legal Business Name): LAYNE K MCGEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DERR RD
SPRINGFIELD OH
45503-2439
US

IV. Provider business mailing address

2355 DERR RD
SPRINGFIELD OH
45503-2439
US

V. Phone/Fax

Practice location:
  • Phone: 937-629-0100
  • Fax:
Mailing address:
  • Phone: 740-238-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.007515RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: