Provider Demographics
NPI:1265853279
Name:MCDONALD, KALYN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KALYN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3326
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3326
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01849231H00000X
NC11920231H00000X
SC4049231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1249003OtherWELLCARE OF SC
NC1265853279Medicaid
NC19K7EOtherBCBSNC
5633877OtherAETNA
SCSAN135Medicaid
NCQ53889AMedicare PIN
NC19K7EOtherBCBSNC