Provider Demographics
NPI:1881671303
Name:MCCRORY, KATHLEEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E MARSHALL AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5563
Mailing Address - Country:US
Mailing Address - Phone:903-247-7700
Mailing Address - Fax:
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5563
Practice Address - Country:US
Practice Address - Phone:903-247-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72460Medicare UPIN