Kevin P McNeeley, PHYSICIAN ASSISTANT

Key facts

NPI

1376739243

Entity type

Individual (NPI type 1)

Primary specialty

Medical Physician Assistant 363AM0700X

License

1557 (TN)

Practice address

2302 Madison St
Clarksville, TN 37043-5453

Phone

(931) 245-2400

NPI assigned

Sep 24, 2007

Sex

Male

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Physicians of Montgomery County, PLLC Emergency Medicine Physician · Clarksville, TN · NPI 1336166388
  NPD (past) PHYSICIAN ASSISTANT
• Clinic Regional Physicians LLC Internal Medicine Physician · Beachwood, OH · NPI 1043470453
  NPD (past)
• Meridia Medical Group, LLC Specialist · Warrensville Heights, OH · NPI 1316992944
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 28, 2014.

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401235200000",
    "number": "1376739243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 OLD HIGHWAY 13",
            "city": "CUMBERLAND CITY",
            "state": "TN",
            "postal_code": "370509546",
            "telephone_number": "931-302-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 MADISON ST",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370435453",
            "telephone_number": "931-245-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNEELEY",
        "first_name": "KEVIN",
        "middle_name": "P",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-24",
        "last_updated": "2014-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "1557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

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• Jada McMillian
• Stephanie Jane McMurry, R.D.
• Cassidi McNally, MSCJ
• Michael Justin McNaught, D.D.S
• Alyssa Joy McNeely
• Lindsey McNeil
• Rebekah McNeilly
• Danielle Ann McRae, MS
• Ernestine McSwain, LPN

All providers in Clarksville, TN · Medical Physician Assistant in Tennessee