Individual
MR. KELLY L. MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
903 5TH ST # C, ESTANCIA, NM 87016-1155
(505) 384-2777
Mailing address
903 5TH ST # C, ESTANCIA, NM 87016-1155
(505) 384-2777
(505) 384-2204
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
237
NM
363A00000X
Physician Assistant
Primary
PA2013-0057
NM
Other
Enumeration date
08/15/2006
Last updated
09/08/2023
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