Provider Demographics
NPI:1215704010
Name:MCNEALY, BERNESSA MARTIN
Entity type:Individual
Prefix:
First Name:BERNESSA
Middle Name:MARTIN
Last Name:MCNEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 KELLYS TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2319
Mailing Address - Country:US
Mailing Address - Phone:336-989-4625
Mailing Address - Fax:336-724-4783
Practice Address - Street 1:4605 KELLYS TRL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2319
Practice Address - Country:US
Practice Address - Phone:336-989-4625
Practice Address - Fax:336-724-4783
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health