Provider Demographics
NPI:1346780798
Name:NEELEY, BLAKE ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ALLEN
Last Name:NEELEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 AUTUMN MIST WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-4530
Mailing Address - Country:US
Mailing Address - Phone:281-733-9592
Mailing Address - Fax:
Practice Address - Street 1:4218 GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7900
Practice Address - Country:US
Practice Address - Phone:817-283-1860
Practice Address - Fax:817-283-2175
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant