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General NPI Number Information
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NPI Number | 1073369104
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Entity Type | Individual
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Provider Name | KYNESSA PATRICE MCCRAY HHP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2024
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 13100 WORTHAM CENTER DR FL 3
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City | HOUSTON
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State | TX
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Zip | 77065-5625
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Country | US
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Telephone | 310-505-7444
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Fax |
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Provider Business Mailing Address
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Address Line | 11403 BARKER CYPRESS RD STE J
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City | CYPRESS
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State | TX
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Zip | 77433-5398
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Country | US
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Telephone | 310-505-7444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 46343807
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License Number State | TX
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