Provider Demographics
NPI:1568187623
Name:NEELY, JAYLEN KISHUN (CPT)
Entity Type:Individual
Prefix:
First Name:JAYLEN
Middle Name:KISHUN
Last Name:NEELY
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Gender:M
Credentials:CPT
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Mailing Address - Street 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2146 FRAYSER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5755
Practice Address - Country:US
Practice Address - Phone:901-302-4361
Practice Address - Fax:865-342-0121
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy