Healthcare Provider Details

I. General information

NPI: 1962742536
Provider Name (Legal Business Name): ASHLEY KAY MCDONALD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N SUITE 605
ROBBINSDALE MN
55422-2948
US

IV. Provider business mailing address

11850 BLACKFOOT ST NW STE 490
COON RAPIDS MN
55433-2773
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-2940
  • Fax: 763-520-2943
Mailing address:
  • Phone: 763-520-2940
  • Fax: 763-520-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: