Provider Demographics
NPI:1639163108
Name:NEELY, ANGELA B (RN MSN FNO-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:NEELY
Suffix:
Gender:F
Credentials:RN MSN FNO-C
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Mailing Address - Street 1:102 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6085
Mailing Address - Country:US
Mailing Address - Phone:337-277-8345
Mailing Address - Fax:
Practice Address - Street 1:376 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANKTON
Practice Address - State:LA
Practice Address - Zip Code:70584-5920
Practice Address - Country:US
Practice Address - Phone:337-668-4141
Practice Address - Fax:337-668-4386
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP04758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1G6741OtherFAMILY PRACTICE
LA193862Medicare Oscar/Certification