Provider Demographics
NPI:1801614482
Name:NEELY, LAKEEA
Entity type:Individual
Prefix:
First Name:LAKEEA
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3965
Mailing Address - Country:US
Mailing Address - Phone:317-778-2707
Mailing Address - Fax:
Practice Address - Street 1:3153 N PARK AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3965
Practice Address - Country:US
Practice Address - Phone:317-778-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QV0200X, 302R00000X, 347C00000X
IN311ZA0620X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle