Individual
MS. KATHLEEN A MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1009 SPRUCE ST, ESPANOLA, NM 87532-2740
(505) 747-4144
(505) 747-3213
Mailing address
1009 SPRUCE ST, ESPANOLA, NM 87532-2740
(505) 747-4144
(505) 747-3213
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA2003-0045
NM
363AS0400X
Surgical Physician Assistant
Primary
PA2003-0045
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67289258
—
NM
Enumeration date
08/30/2006
Last updated
04/02/2013
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