Provider Demographics
NPI:1073369104
Name:MCCRAY, KYNESSA PATRICE (HHP)
Entity type:Individual
Prefix:
First Name:KYNESSA
Middle Name:PATRICE
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:KYNESSA
Other - Middle Name:PATRICE
Other - Last Name:MCCRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11403 BARKER CYPRESS RD STE J
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5398
Mailing Address - Country:US
Mailing Address - Phone:310-505-7444
Mailing Address - Fax:
Practice Address - Street 1:13100 WORTHAM CENTER DR FL 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5625
Practice Address - Country:US
Practice Address - Phone:310-505-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46343807133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist