Provider Demographics
NPI:1811231889
Name:MCKENNA, CATHERINE SUE (RN, BSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:RN, BSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N GARFIELD ST
Mailing Address - Street 2:SUITE 271
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5904
Mailing Address - Country:US
Mailing Address - Phone:432-685-0633
Mailing Address - Fax:
Practice Address - Street 1:400 N GARFIELD ST
Practice Address - Street 2:SUITE 271
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5904
Practice Address - Country:US
Practice Address - Phone:432-685-0633
Practice Address - Fax:432-685-1043
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily