Provider Demographics
NPI:1366550139
Name:NEIL, KERRY LYNN (FNP LPA)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LYNN
Last Name:NEIL
Suffix:
Gender:F
Credentials:FNP LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-734-4404
Mailing Address - Fax:360-734-7409
Practice Address - Street 1:3130 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1904
Practice Address - Country:US
Practice Address - Phone:360-734-4404
Practice Address - Fax:360-734-7409
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60600270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0396137303Medicaid
558202Medicare UPIN
8A9604Medicare ID - Type Unspecified