Provider Demographics
NPI:1891196606
Name:NEELY, AUDREY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials: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:PO BOX 8255
Mailing Address - Street 2:1 MEDICAL CENTER DRIVE
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-8255
Mailing Address - Country:US
Mailing Address - Phone:304-598-4000
Mailing Address - Fax:304-598-4930
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:ANESTHESIOLOGY
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-8255
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:304-598-4930
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV78333163W00000X
WVAPRN78333-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse