Healthcare Provider Details

I. General information

NPI: 1467269449
Provider Name (Legal Business Name): KAITLIN BRIANA MCNEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COTTON CREEK RD
STAR NC
27356-7954
US

IV. Provider business mailing address

103 COTTON CREEK RD
STAR NC
27356-7954
US

V. Phone/Fax

Practice location:
  • Phone: 910-492-4646
  • Fax: 910-226-7432
Mailing address:
  • Phone: 910-492-4646
  • Fax: 910-226-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: