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Kaila Gaughan

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3400 Spruce St, Philadelphia, PA 19104-4238

PECOS Enrollment

Based on the most recent information from CMS, provider Kaila Gaughan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1134764574
Provider Type
Individual
Full Name
Gaughan, Kaila
Credential
PA-C

Gender
Female
Sole Proprietor
Yes
Enumeration Date
11/8/2019
Last Updated
8/28/2023

Contact Information

Practice Location

3400 Spruce St, Philadelphia, PA 19104-4238

(215) 662-4000

Unlisted Fax

Mailing Location

3400 Spruce St, Philadelphia, PA 19104-4238

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License MA064141 Pennsylvania
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA2604 Kentucky

Kaila Gaughan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Shah, Jaimin J

Dons, Katerina

Monterrosa, Christina

Raihl, Olivia Paige

Fareri, Maria

Grillo, Heather L

Ziegler, Pamela Jayne

Averna, Tiffany Ann

Cederquist, Kelly Lauren

Miller, Megan