Provider Demographics
NPI:1700943933
Name:NEELY, RELA A (FNP)
Entity type:Individual
Prefix:MRS
First Name:RELA
Middle Name:A
Last Name:NEELY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 SW GEMINI DR, PMB 49084
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:346-646-3619
Mailing Address - Fax:713-461-5307
Practice Address - Street 1:14317 CYPRESS ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7801
Practice Address - Country:US
Practice Address - Phone:346-646-3619
Practice Address - Fax:713-461-5307
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121184363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341162Medicaid
TN3341162Medicare PIN