Provider Demographics
NPI:1194194290
Name:MCGRATH, KELLY BLOUNT (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BLOUNT
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:5085 MORGANTON RD STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1497
Practice Address - Country:US
Practice Address - Phone:910-323-3890
Practice Address - Fax:910-323-4509
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2025-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-14134363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant