Healthcare Provider Details

I. General information

NPI: 1881671303
Provider Name (Legal Business Name): KATHLEEN A MCCRORY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E MARSHALL AVE SUITE 1002
LONGVIEW TX
75601-5563
US

IV. Provider business mailing address

705 E MARSHALL AVE SUITE 1002
LONGVIEW TX
75601-5563
US

V. Phone/Fax

Practice location:
  • Phone: 903-247-7700
  • Fax:
Mailing address:
  • Phone: 903-247-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK1253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: