Provider Demographics
NPI:1841239738
Name:NEELY, KIMBERLY R (GNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:NEELY
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8198 WALNUT HILL LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4316
Mailing Address - Country:US
Mailing Address - Phone:214-345-8000
Mailing Address - Fax:
Practice Address - Street 1:8198 WALNUT HILL LN
Practice Address - Street 2:SUITE A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4316
Practice Address - Country:US
Practice Address - Phone:214-345-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107482363LG0600X
TX631908163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117391607Medicaid
TNBC/BSOther8N7188
TX8B5812Medicare PIN
TXP00116308Medicare PIN
TX117391607Medicaid