Provider Demographics
NPI:1992026868
Name:MCALVANY, KELLY LYNNE (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:MCALVANY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRETTWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8021
Mailing Address - Country:US
Mailing Address - Phone:828-452-9700
Mailing Address - Fax:828-452-3701
Practice Address - Street 1:15 BRETTWOOD TRCE
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8021
Practice Address - Country:US
Practice Address - Phone:828-452-9700
Practice Address - Fax:828-452-3701
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-00108208800000X
MN54190208800000X
TXQ3233208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024473Medicaid
TN6078664OtherBLUE CROSS