Provider Demographics
NPI:1982683397
Name:NEAL, KATHLEEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:R
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1715 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7989
Mailing Address - Country:US
Mailing Address - Phone:970-336-1500
Mailing Address - Fax:970-336-1505
Practice Address - Street 1:1715 61ST AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7989
Practice Address - Country:US
Practice Address - Phone:970-336-1500
Practice Address - Fax:970-336-1505
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240882207V00000X
CODR.0053738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1982683397Medicaid
CO378585YLB8Medicare PIN
OHA17154Medicare UPIN