Provider Demographics
NPI:1124232475
Name:KNEELAND, MISTY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LEE
Last Name:KNEELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:LEE
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 452035
Mailing Address - Street 2:
Mailing Address - City:SURINSE
Mailing Address - State:FL
Mailing Address - Zip Code:33345
Mailing Address - Country:US
Mailing Address - Phone:501-225-3909
Mailing Address - Fax:
Practice Address - Street 1:700 W. GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DARADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:501-614-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262957207L00000X
GA77841207L00000X
NC01371207L00000X
WI68751-20207L00000X
FL144982207L00000X
NY304089207L00000X
ARE-6522207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AF67155Medicare PIN