Provider Demographics
NPI:1982468468
Name:KELLY, NEIL FRANCIS (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:FRANCIS
Last Name:KELLY
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19005 W 159TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8992
Mailing Address - Country:US
Mailing Address - Phone:816-804-8996
Mailing Address - Fax:
Practice Address - Street 1:19005 W 159TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8992
Practice Address - Country:US
Practice Address - Phone:816-804-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5382730072363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care