| Doctor Name: | KELLY JO MCDERMOTT |
| NPI Number: | 1114386794 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CP001027 |
| Business Practice Address: | 525 N Foster St Mitchell, SD - 573012966 |
| Business Phone Number: | 6059955701 |
| Business Fax Number: | 6059955700 |
| Mailing Address: | 525 N Foster St, MITCHELL |
| State: | SD |
| Postal Code: | 573012966 |
| Phone Number: | 6059955701 |
| Fax Number: | 6059955700 |
| NPI Enumeration Date: | 02/11/2016 |
| NPI Last Update Date: | 02/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CP001027 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |