Provider Demographics
NPI:1215462999
Name:FARRELL, KAMEALYA LEAH (FNP-C, RN)
Entity type:Individual
Prefix:MRS
First Name:KAMEALYA
Middle Name:LEAH
Last Name:FARRELL
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 S SERVICE RD W STE 10
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2306
Mailing Address - Country:US
Mailing Address - Phone:573-468-4455
Mailing Address - Fax:
Practice Address - Street 1:1326 S SERVICE RD W STE 10
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080
Practice Address - Country:US
Practice Address - Phone:573-468-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017009934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily