Healthcare Provider Details

I. General information

NPI: 1033101951
Provider Name (Legal Business Name): KATHERINE GRACE MCDONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CRYSTAL RUN RD
MIDDLETOWN NY
10941-4028
US

IV. Provider business mailing address

PO BOX 411730
BOSTON MA
02241-1730
US

V. Phone/Fax

Practice location:
  • Phone: 845-703-6999
  • Fax: 845-703-6297
Mailing address:
  • Phone: 845-703-6999
  • Fax: 845-703-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: