=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811891377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE JAMES MACDONALD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14200 W CELEBRATE LIFE WAY
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-207-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 E PRINCESS DR APT 1136
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Registered Nurse
-----------------------------------------------------
License Number | 277078
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------