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NPI Code Detail

MEDICARE: MRS. KATELYN ELYSE MACDONALD PA-C

MEDICARE: MRS. KATELYN ELYSE MACDONALD 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
1363A00000XPhysician AssistantPA-1809ID

General Provider Information

NPI Number : 1871136978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATELYN ELYSE MACDONALD PA-C
Provider Business Mailing Address
First Line : PO BOX 9
Second Line :
City : NAMPA
State : ID
Zip : 83653-0009
Country : US
Telephone Number : 208-467-4431
Fax Number : 208-466-5359
Provider Business Practice Location Address
First Line : 808 CLEVELAND BLVD
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4168
Country : US
Telephone Number : 208-459-1025
Fax Number : 208-466-5359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2019
Last Update Date : 05/05/2021

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