Provider Demographics
NPI:1629494711
Name:NELAND, KELLY (DNP, FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NELAND
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 E 350 HWY
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1808
Mailing Address - Country:US
Mailing Address - Phone:816-268-3001
Mailing Address - Fax:816-268-3002
Practice Address - Street 1:10301 E 350 HWY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-1808
Practice Address - Country:US
Practice Address - Phone:816-268-3001
Practice Address - Fax:816-268-3002
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014003277363LF0000X
MO2022029286363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily