Provider Demographics
NPI:1154328896
Name:PARNELL, KELLEY JANE (MD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:JANE
Last Name:PARNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:JANE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1305 W AMERICAN DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1993
Mailing Address - Country:US
Mailing Address - Phone:800-201-1194
Mailing Address - Fax:920-720-7392
Practice Address - Street 1:1305 W AMERICAN DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1993
Practice Address - Country:US
Practice Address - Phone:800-201-1194
Practice Address - Fax:920-720-7392
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050034A2084N0400X
WI55785207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200212580Medicaid
114860TMedicare PIN
ING443371Medicare UPIN
IN200212580Medicaid
IN237290AMedicare PIN