Provider Demographics
NPI:1780803254
Name:NEIL, KELLY LYNN (FNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNN
Last Name:NEIL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 28199
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0199
Mailing Address - Country:US
Mailing Address - Phone:858-613-8900
Mailing Address - Fax:858-618-1523
Practice Address - Street 1:15611 POMERADO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-675-3272
Practice Address - Fax:858-613-2930
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA12872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFZ205ZMedicare PIN