Provider Demographics
NPI:1639721293
Name:NEVILLE, MCKENNA (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MCKENNA
Middle Name:
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 W 300 S
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-5503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9348 E RITA RD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-6303
Practice Address - Country:US
Practice Address - Phone:520-324-1036
Practice Address - Fax:520-324-1035
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94188383102163WP0200X
UT9418838-4405363LF0000X
UT9418838-8900363LF0000X
AZ257364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094543Medicaid