Provider Demographics
NPI:1518245166
Name:MCDONALD, AMY LYNN (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3024 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4037
Mailing Address - Country:US
Mailing Address - Phone:817-494-5000
Mailing Address - Fax:817-494-5001
Practice Address - Street 1:300 S NOLEN DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8057
Practice Address - Country:US
Practice Address - Phone:817-989-2400
Practice Address - Fax:817-549-8463
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2023-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377340YKPWMedicare PIN