MEDICARE: KRISTY LEE MCDONALD NP

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
1	363LF0000X	Family Nurse Practitioner	RN302004	GA
2	363LF0000X	Family Nurse Practitioner	209031003	IL

General Provider Information

NPI Number	:	1861034365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY LEE MCDONALD NP

Provider Business Mailing Address
First Line	:	1661 FEEHANVILLE DR STE 120
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6017
Country	:	US
Telephone Number	:	847-305-8600
Fax Number	:	847-305-8601

Provider Business Practice Location Address
First Line	:	1661 FEEHANVILLE DR STE 120
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6017
Country	:	US
Telephone Number	:	847-305-8600
Fax Number	:	847-305-8601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	12/09/2024

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