| Doctor Name: | KATHLEEN MARIE MCINNIS |
| NPI Number: | 1003985342 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NNP |
| License Number: | 253573 |
| Business Practice Address: | 2200 Bergquist Dr Ste 1 Attn Credentials (cmc) Lackland A F B, TX - 782369908 |
| Business Phone Number: | 2102926679 |
| Business Fax Number: | |
| Mailing Address: | 313 Windcrest Dr, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782392421 |
| Phone Number: | 2106376335 |
| Fax Number: | |
| NPI Enumeration Date: | 11/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0000X |
| License Number: | 253573 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal |
| Taxonomy Definition: | |