MRS. KELLY LEIGH MACK (NPI# 1396813960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396813960 |
| Entity Type | Individual |
| Full Name | MRS. KELLY LEIGH MACK |
| Credential | PA-C |
| Practice Address |
995 N. Prince Frederick Blvd Suite 204 Prince Frederick MD 20678 |
| Mailing Address |
4505 Kingwood Dr Ste 185 Kingwood TX 77345-2618 |
| Practice Telephone | 4105355855 |
| Practice Fax Number | 4105356574 |
| Mailing Telephone | 2817475533 |
| Mailing Fax Number | 2817475534 |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2019-08-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA07662 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA18061 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578896460 | Kelly Mack | Speech-Language Pathologist | 2124 16th St, Boulder, CO 80302-4354 | 2009-09-10 |
| 1215184056 | Kelly Mack | Physical Therapist | 107 Holly Creek Dr, Irmo, SC 29063-8918 | 2008-08-23 |
| 1780702472 | Kelly Wade Mack | Dentist | 2200 Horseshoe Ln, Longview, TX 75605-5648 | 2007-03-27 |
| 1003468273 | Kelly Lynne Mack | Nurse Practitioner | 2215 Burdett Ave, Troy, NY 12180-2466 | 2019-07-09 |
| 1972933646 | Kelly Mack | Physical Therapy Assistant | 44480 W Honeycutt Rd, #106, Maricopa, AZ 85138-2903 | 2013-11-17 |
| 1164692455 | Kelly Jene Mack | Counselor | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2008-03-03 |
| 1457471542 | Kelly S Mack | Nurse Practitioner | 6001 Research Park Blvd, Madison, WI 53719 | 2007-03-30 |
| 1982742888 | Kelly C Mack | Nurse Practitioner | 1800 Williams St, Suite 200, Denver, CO 80218-1234 | 2007-02-02 |
| 1245308899 | Kelly Anne Mack | Dental Hygienist | 55 E Loop Rd, Grove Dental Assoc Suite 201, Wheaton, IL 60187 | 2006-12-01 |
| Street Address |
995 N. PRINCE FREDERICK BLVD SUITE 204 |
| City | PRINCE FREDERICK |
| State | MD |
| Zip Code | 20678 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760869382 | Tamara Bonsack Cheater | Nurse Practitioner | 995 N. Prince Frederick Blvd, Suite 204, Prince Frederick, MD 20678 | 2015-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861857500 | Watershed Counseling Service | Counselor | 246 Merrimac Court, Prince Frederick, MD 20678 | 2015-12-23 |
| 1023449642 | Mary Gordon Walter | Registered Nurse | 976 Solomans Island Road, Prince Frederick, MD 20678 | 2013-12-07 |
| 1891126827 | Jacqueline Leclercq | Nurse Practitioner | 110 Hospital Road Suite 303, Prince Frederick, MD 20678 | 2013-12-02 |
| 1174959001 | Linsey Rowe Heane | Physical Therapist | 110 Main Street Suite 1, Prince Frederick, MD 20678 | 2013-09-24 |
| 1053607002 | Tidewater Dental Pf | Dentist | 690 Prince Frederick Blvd, Prince Frederick, MD 20678 | 2011-06-28 |
| 1033411558 | Sharon Patricia Parran | Pharmacist | 80 W.dares Beach Road, Prince Frederick, MD 20678 | 2010-12-04 |
| 1366684326 | Prince Frederick Surgery Center LLC | Clinic/Center | 70 Sherry Lane, Suite 101, Prince Frederick, MD 20678 | 2009-04-06 |
| 1982844734 | Orthocare Solutions Inc | Durable Medical Equipment & Medical Supplies | 220 Old Solomans Island Rd, Prince Frederick, MD 20678 | 2009-03-05 |
| 1225273519 | Rebecca Lynn Jahed | Audiologist | 3180 Blackberry Lane, Prince Frederick, MD 20678 | 2008-12-16 |
| 1669639209 | Ralph Walter Niemann | Dentist | 272 Merrimac Court, Prince Frederick, MD 20678 | 2008-05-21 |
| Find all providers in zip 20678 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164899241 | Kenneth L Ferrera | Physician Assistant | 995 Prince Frederick Blvd, Suite 204, Prince Frederick, MD 20678-3198 | 2015-08-25 |
| 1700215431 | Samantha L Keiter | Physician Assistant | 110 Hospital Rd, Suite 310, Prince Frederick, MD 20678-4019 | 2013-11-04 |
| 1295774438 | John W. Leroy | Physician Assistant | 100 Hospital Rd, Prince Frederick, MD 20678-4017 | 2006-06-05 |
| 1215976402 | Barry L. Myers | Physician Assistant | 100 Hospital Rd, Prince Frederick, MD 20678-4017 | 2006-06-05 |
| 1457305682 | Christina A Athens | Physician Assistant | 100 Hospital Rd, Prince Frederick, MD 20678-4017 | 2006-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336767227 | Merlyn Angella Boakai | Physician Assistant | 800 Sero Pine Ln, Fort Washington, MD 20744-5954 | 2020-07-08 |
| 1831730878 | Jennifer Bacher | Physician Assistant | 1185 Imperial Dr Ste 201, Hagerstown, MD 21740-6673 | 2019-10-01 |
| 1831747971 | Miriam Noelle Meiser | Physician Assistant | 10750 Columbia Pike Unit 401a, Silver Spring, MD 20901-4402 | 2019-09-02 |
| 1285296913 | Mary Furda | Physician Assistant | 20680 Seneca Meadows Pkwy Ste 206, Germantown, MD 20876 | 2019-07-02 |
| 1902466998 | Christina Deleon | Physician Assistant | 403 Marvel Court, Easton, MD 21601 | 2019-06-20 |
| 1467012369 | Molly Uebele Harrigan | Physician Assistant | 5225 Pooks Hill Rd Apt 1007n, Bethesda, MD 20814-2041 | 2019-06-13 |
| 1558834234 | Kevin Timothy Johnson | Physician Assistant | 411 Naylor Mill Rd, Salisbury, MD 21801-1191 | 2019-01-06 |
| 1093287260 | Carolina Radzyminska Johnson | Physician Assistant | 10750 Columbia Pike Ste 401, Silver Spring, MD 20901-4402 | 2018-12-27 |
| 1962971309 | Emmy L Estrada | Physician Assistant | 12150 Annapolis Rd Ste 208, Glenn Dale, MD 20769-9183 | 2018-11-14 |
| 1982170833 | Barbara Argyros | Physician Assistant | 1415 S. Mountain Road, Suite 100, Joppa, MD 21085 | 2018-10-18 |
| Find all providers with the same taxonomy | ||||
| City | PRINCE FREDERICK |
| Zip Code | 20678 |
Please comment or provide details below to improve the information on MRS. KELLY LEIGH MACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.