Provider Demographics
NPI:1326110404
Name:MCNEILLY, KATHY LEA (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LEA
Last Name:MCNEILLY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SE DORION AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2580
Mailing Address - Country:US
Mailing Address - Phone:541-276-0679
Mailing Address - Fax:541-276-0805
Practice Address - Street 1:202 SE DORION AVE STE 103
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2580
Practice Address - Country:US
Practice Address - Phone:541-276-0679
Practice Address - Fax:541-276-0805
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health