Provider Demographics
NPI:1962118257
Name:MCNALLY, KATHLEEN A (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22 COUNTRY LIFE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2710
Mailing Address - Country:US
Mailing Address - Phone:163-638-5292
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1366
Practice Address - Country:US
Practice Address - Phone:363-755-6500
Practice Address - Fax:636-755-6505
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116761163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation