Provider Demographics
NPI:1558063867
Name:FARIA, NELLEDA LYNN (RN BSN MBA)
Entity Type:Individual
Prefix:
First Name:NELLEDA
Middle Name:LYNN
Last Name:FARIA
Suffix:
Gender:F
Credentials:RN BSN MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9456
Mailing Address - Country:US
Mailing Address - Phone:785-580-5673
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD SDTP BEHAVIORAL HEALTH UNIT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-580-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS90551163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health