Healthcare Provider Details

I. General information

NPI: 1053313064
Provider Name (Legal Business Name): KIMBERLY WELTY MCDONALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 CREEKSIDE LANDING DR
APEX NC
27502-3982
US

IV. Provider business mailing address

2515 ANDERSON DR
RALEIGH NC
27608-1407
US

V. Phone/Fax

Practice location:
  • Phone: 252-717-7291
  • Fax:
Mailing address:
  • Phone: 252-717-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2005-01324
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2005-01324
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: