Provider Demographics
NPI:1417387333
Name:MCNEELY, CHRISTY (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-0099
Mailing Address - Country:US
Mailing Address - Phone:864-847-7344
Mailing Address - Fax:864-947-1162
Practice Address - Street 1:2001 EASLEY HWY
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7520
Practice Address - Country:US
Practice Address - Phone:864-947-9787
Practice Address - Fax:864-947-1162
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC576001200251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104973577Medicaid