Provider Demographics
NPI:1609932128
Name:NEELEY, SHARON N (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:N
Last Name:NEELEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:N
Other - Last Name:NEELEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-0310
Mailing Address - Country:US
Mailing Address - Phone:606-298-7758
Mailing Address - Fax:606-298-7759
Practice Address - Street 1:RT. 3 NORTH
Practice Address - Street 2:MARTIN COUNTY MEDICAL COMPLEX
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-0310
Practice Address - Country:US
Practice Address - Phone:606-298-7758
Practice Address - Fax:606-298-7759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6680122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45602802OtherEPSDT
KY60066800Medicaid