Provider Demographics
NPI:1275412678
Name:MCNEELY, STACIA (PMHNP)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 BUTTERCUP RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-8513
Mailing Address - Country:US
Mailing Address - Phone:303-525-6698
Mailing Address - Fax:
Practice Address - Street 1:1828 BUTTERCUP RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-8513
Practice Address - Country:US
Practice Address - Phone:303-525-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0109910-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health