Provider Demographics
NPI:1790409977
Name:KELLY, MCKAYLA E (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:503 MUIR ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1848
Mailing Address - Country:US
Mailing Address - Phone:410-228-4045
Mailing Address - Fax:833-908-2286
Practice Address - Street 1:503 MUIR ST STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1848
Practice Address - Country:US
Practice Address - Phone:410-228-4045
Practice Address - Fax:833-908-2286
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2023-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0009029363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant