Provider Demographics
NPI:1831286954
Name:MCCURDY, KELLY SUE (PA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:SUE
Last Name:MCCURDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:SUE
Other - Last Name:PRESTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:21928 MIKHAIL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5720
Mailing Address - Country:US
Mailing Address - Phone:661-263-6807
Mailing Address - Fax:
Practice Address - Street 1:544 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3311
Practice Address - Country:US
Practice Address - Phone:818-241-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant