Provider Demographics
NPI:1669299947
Name:KEARNEY, MICHAEL SCOTT (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20125 FM 1314 RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-7490
Mailing Address - Country:US
Mailing Address - Phone:281-306-2102
Mailing Address - Fax:
Practice Address - Street 1:20125 FM 1314
Practice Address - Street 2:SUITE A
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-7490
Practice Address - Country:US
Practice Address - Phone:281-306-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner