Provider Demographics
NPI:1841681558
Name:NEELY, TAMARA (DNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13048 ODELL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-4388
Mailing Address - Country:US
Mailing Address - Phone:704-724-7041
Mailing Address - Fax:704-335-8477
Practice Address - Street 1:4301 MORRIS PARK DR STE 14
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-8253
Practice Address - Country:US
Practice Address - Phone:704-335-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018077349363LP0808X
NC5007342363LF0000X
NCF0914874363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care