Provider Demographics
NPI:1659349629
Name:NEELEY, MARY ANN (PHD, FNP, RN)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:NEELEY
Suffix:
Gender:F
Credentials:PHD, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34319 FULSHEAR FARMS RD
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-4334
Mailing Address - Country:US
Mailing Address - Phone:281-533-0529
Mailing Address - Fax:
Practice Address - Street 1:400 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4406
Practice Address - Country:US
Practice Address - Phone:281-342-1746
Practice Address - Fax:281-342-3832
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0127147Medicaid
TX8A4111Medicare ID - Type Unspecified
TX0127147Medicaid