Provider Demographics
NPI:1215597307
Name:MCSHINE-GREGORY, KAMILAH (CHWC)
Entity type:Individual
Prefix:
First Name:KAMILAH
Middle Name:
Last Name:MCSHINE-GREGORY
Suffix:
Gender:F
Credentials:CHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19839 MOONRIVER DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-1824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28420 HARDY TOLL RD STE 205
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8083
Practice Address - Country:US
Practice Address - Phone:408-665-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator