Provider Demographics
NPI:1487265161
Name:MCNEELY, SHERRY LYNN (NURSE)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 N GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-1400
Mailing Address - Country:US
Mailing Address - Phone:812-752-8455
Mailing Address - Fax:812-752-6023
Practice Address - Street 1:1296 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-1400
Practice Address - Country:US
Practice Address - Phone:812-752-8455
Practice Address - Fax:812-752-6023
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27046340A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1609857259Medicaid
IN1174956262Medicaid