Healthcare Provider Details

I. General information

NPI: 1952875494
Provider Name (Legal Business Name): KARLEIGH NICOLE NEESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24452 OLD FOLEY RD
ELBERTA AL
36530-2522
US

IV. Provider business mailing address

24452 OLD FOLEY RD
ELBERTA AL
36530-2522
US

V. Phone/Fax

Practice location:
  • Phone: 251-424-3714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS12297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: