Provider Demographics
NPI:1346353596
Name:MCNEESE, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCNEESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TRADE ST
Mailing Address - Street 2:P.O.BOX 1659
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-7008
Mailing Address - Country:US
Mailing Address - Phone:252-789-4001
Mailing Address - Fax:252-799-0204
Practice Address - Street 1:108 TRADE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-7008
Practice Address - Country:US
Practice Address - Phone:252-789-4001
Practice Address - Fax:252-799-0204
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958033Medicaid
NC110225016OtherRAILROAD MEDICARE
NC58033OtherBLUE CROSS BLUE SHIELD
E90405Medicare UPIN
NC110225016OtherRAILROAD MEDICARE