Provider Demographics
NPI:1477018141
Name:MCNEESE, KATHY LEA (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEA
Last Name:MCNEESE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LEA
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4027
Mailing Address - Country:US
Mailing Address - Phone:936-568-8430
Mailing Address - Fax:
Practice Address - Street 1:1018 N MOUND ST STE 205
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4434
Practice Address - Country:US
Practice Address - Phone:936-569-9472
Practice Address - Fax:936-569-4664
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily