Provider Demographics
NPI:1891682423
Name:NEELY, LATANYA LYNETTE (APRN-FNP)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:LYNETTE
Last Name:NEELY
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 90TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7160
Mailing Address - Country:US
Mailing Address - Phone:219-736-2922
Mailing Address - Fax:855-820-7118
Practice Address - Street 1:118 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7160
Practice Address - Country:US
Practice Address - Phone:219-736-2922
Practice Address - Fax:855-820-7118
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016738A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner