Kory McCullah, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603

Phone

(315) 774-2359

NPI assigned

May 23, 2023

Last updated

Jun 9, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1902598568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5187 STATE HIGHWAY 56",
            "city": "COLTON",
            "state": "NY",
            "postal_code": "136257785",
            "telephone_number": "907-799-9792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136022603",
            "telephone_number": "315-774-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLAH",
        "first_name": "KORY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-23",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Matsas, MD
• Angela Matthews, LCSW
• Robert Landis Mauger III, MD
• John Lewis McAfee
• Sean Douglas McCormick, PSY.D.
• Benjamin McDaniels, DPT
• Megan Marie McGinty
• Deshawn McGowan
• Sarah Marie McSherry, DMD
• Rhiannon McWherter, MS OTR/L

• Physician Assistant in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.