Provider Demographics
NPI:1376739243
Name:MCNEELEY, KEVIN P (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:MCNEELEY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 OLD HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37050-9546
Mailing Address - Country:US
Mailing Address - Phone:931-302-4570
Mailing Address - Fax:
Practice Address - Street 1:2302 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5453
Practice Address - Country:US
Practice Address - Phone:931-245-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN1557363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant