MEDICARE: KELLY LELIA MCDONOUGH 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	363LN0000X	Neonatal Nurse Practitioner	APRN1195514	TX
2	363LN0000X	Neonatal Nurse Practitioner	ARNP9173823	FL
3	363LN0000X	Neonatal Nurse Practitioner	APN0001891	CO
4	363L00000X	Nurse Practitioner	6597	MN
5	363LN0005X	Critical Care Neonatal Nurse Practitioner	6597	MN
6	363L00000X	Nurse Practitioner	4704431428	MI
7	363LN0000X	Neonatal Nurse Practitioner	6597	MN
8	363LN0005X	Critical Care Neonatal Nurse Practitioner	ARNP9173823	FL

General Provider Information

NPI Number	:	1881080232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LELIA MCDONOUGH NP

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	929 GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2515
Country	:	US
Telephone Number	:	713-242-3000
Fax Number	:	713-338-6466

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

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/06/2026

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