Provider Demographics
NPI:1790495778
Name:NEALEY, HEIDI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:NEALEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9117 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5434
Mailing Address - Country:US
Mailing Address - Phone:571-358-1275
Mailing Address - Fax:
Practice Address - Street 1:9117 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5434
Practice Address - Country:US
Practice Address - Phone:571-358-1275
Practice Address - Fax:888-358-1275
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health