Basic Information
Provider Information | |||||||||
NPI: | 1508256322 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCNEELY | ||||||||
FirstName: | KATHLEEN | ||||||||
MiddleName: | MARY | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, CNS, LDN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCNEELY | ||||||||
OtherFirstName: | KATHLEEN | ||||||||
OtherMiddleName: | MARY | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MS, CNS, LDN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1220 12TH STREET, SE | ||||||||
Address2: | UNITY HEALTH CARE, INC. | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 20003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027157949 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1220 12TH STREET, SE | ||||||||
Address2: | UNITY HEALTH CARE, INC. | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 20003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027157949 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/01/2015 | ||||||||
LastUpdateDate: | 04/04/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | DX3757 | MD | N |   | Dietary & Nutritional Service Providers | Nutritionist |   | 133N00000X | NU 100000185 | DC | Y |   | Dietary & Nutritional Service Providers | Nutritionist |   |
No ID Information.