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Contact Information

KELLY L MACK, PA-C
995 N. PRINCE FREDERICK BLVD
SUITE 204
PRINCE FREDERICK, MD20678
 Phone: 410-535-5855
 Fax: 410-535-6574
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KELLY L MACK · (Female)

NPI # 1396813960
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 12/01/2006
Last updated 08/13/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • CA License # PA18061
  • TX License # PA07662
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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