MEDICARE: MR. KENT MCCONNELL AINSLIE 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	4310	AZ

General Provider Information

NPI Number	:	1205088234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENT MCCONNELL AINSLIE PA-C

Provider Business Mailing Address
First Line	:	444 BRUCE ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3450
Country	:	US
Telephone Number	:	530-467-5393
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 S MCCOLL RD STE B
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-1516
Country	:	US
Telephone Number	:	209-276-8918
Fax Number	:

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

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	04/30/2017

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