Provider Demographics
NPI:1154545366
Name:MCNEELY, CONNIE (ARNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1207
Mailing Address - Country:US
Mailing Address - Phone:859-246-7000
Mailing Address - Fax:859-246-7023
Practice Address - Street 1:627 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1207
Practice Address - Country:US
Practice Address - Phone:859-246-7000
Practice Address - Fax:859-246-7023
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3941S363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3491SOtherARNP NUMBER