Provider Demographics
NPI:1699961391
Name:NEAL, KELLY B I (RNFA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:B
Last Name:NEAL
Suffix:I
Gender:F
Credentials:RNFA
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:B
Other - Last Name:HAYNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 POPLAR ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1474
Mailing Address - Country:US
Mailing Address - Phone:304-767-7770
Mailing Address - Fax:304-767-7779
Practice Address - Street 1:500 POPLAR ST STE 304
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1474
Practice Address - Country:US
Practice Address - Phone:304-767-7770
Practice Address - Fax:304-767-7779
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58641163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV58641OtherNURSE LICENSE