Provider Demographics
NPI:1043321672
Name:GLADD, NEELY A (FNP)
Entity Type:Individual
Prefix:
First Name:NEELY
Middle Name:A
Last Name:GLADD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1323
Mailing Address - Country:US
Mailing Address - Phone:260-244-6203
Mailing Address - Fax:260-244-5212
Practice Address - Street 1:524 BRANCH CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1323
Practice Address - Country:US
Practice Address - Phone:260-244-6203
Practice Address - Fax:260-244-5212
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001997A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000528916OtherANTHEM
IN351972384039OtherTRICARE
IN351972384039OtherTRICARE
INQ58233Medicare UPIN
IN070900 VMedicare PIN