Provider Demographics
NPI:1861055212
Name:MCNEIL, KIMBERLY JUANTRICIA (LPN)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:JUANTRICIA
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-9480
Mailing Address - Country:US
Mailing Address - Phone:704-690-3120
Mailing Address - Fax:
Practice Address - Street 1:420 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-9480
Practice Address - Country:US
Practice Address - Phone:704-690-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse