Provider Demographics
NPI:1669299947
Name:KEARNEY, MICHAEL SCOTT (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 FM 1097 RD W STE 140
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-4976
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:
Practice Address - Street 1:9516 FM 1097 RD W STE 140
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-4976
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-224-4205
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner