Provider Demographics
NPI:1548742877
Name:NEELEY, AMBERLY RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:RENEE
Last Name:NEELEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RENEE
Other - Last Name:NEELEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:528 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1402
Mailing Address - Country:US
Mailing Address - Phone:812-882-4434
Mailing Address - Fax:
Practice Address - Street 1:528 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1402
Practice Address - Country:US
Practice Address - Phone:812-882-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146649A363LF0000X
IN71008459A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily