Provider Demographics
NPI:1265255350
Name:NEVILLE, KELLY ROSE (CRNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSE
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 JEANETT WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2556
Mailing Address - Country:US
Mailing Address - Phone:410-627-7945
Mailing Address - Fax:
Practice Address - Street 1:227 GATEWAY DR STE J
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4287
Practice Address - Country:US
Practice Address - Phone:443-643-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181787363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care