Provider Demographics
NPI:1952641045
Name:NEELY, SHERYL L (APRN)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:NEELY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 E OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-3638
Mailing Address - Country:US
Mailing Address - Phone:918-273-0140
Mailing Address - Fax:918-273-0147
Practice Address - Street 1:712 E OSAGE AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-3638
Practice Address - Country:US
Practice Address - Phone:918-273-0140
Practice Address - Fax:918-273-0147
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK65870363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner