Provider Demographics
NPI:1629572268
Name:MCNEILL, KYRSTYN NICHOLE (NP)
Entity Type:Individual
Prefix:
First Name:KYRSTYN
Middle Name:NICHOLE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6599
Mailing Address - Country:US
Mailing Address - Phone:901-692-2779
Mailing Address - Fax:
Practice Address - Street 1:1650 BONNIE LN STE 102
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0517
Practice Address - Country:US
Practice Address - Phone:901-756-2424
Practice Address - Fax:901-756-7504
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000023956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner