Provider Demographics
NPI:1124232475
Name:KNEELAND, MISTY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LEE
Last Name:KNEELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:LEE
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0486
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:
Practice Address - Street 1:2480 HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5093
Practice Address - Country:US
Practice Address - Phone:318-224-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325606207L00000X
WI68751-20207L00000X
VA0101262957207L00000X
GA77841207L00000X
NC01371207L00000X
FL144982207L00000X
NY304089207L00000X
ARE-6522207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AF67155Medicare PIN