Provider Demographics
NPI:1700229580
Name:MCA'NULTY, KALEIGH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:ANN
Last Name:MCA'NULTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PARAMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-5416
Mailing Address - Country:US
Mailing Address - Phone:508-880-0012
Mailing Address - Fax:508-880-0032
Practice Address - Street 1:22 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3924
Practice Address - Country:US
Practice Address - Phone:603-883-1626
Practice Address - Fax:603-881-9914
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4623363AM0700X
NH1078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100761Medicaid