Provider Demographics
NPI:1881279883
Name:NEAL, COLLEEN (APRN: PMHNP-BC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:APRN: PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HWY 47
Mailing Address - Street 2:STE 3115
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-6306
Mailing Address - Country:US
Mailing Address - Phone:979-436-9703
Mailing Address - Fax:979-436-0072
Practice Address - Street 1:3211 INNSBRUCK CIR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6306
Practice Address - Country:US
Practice Address - Phone:979-446-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031762363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1Y0470OtherPTAN