Healthcare Provider Details

I. General information

NPI: 1629517669
Provider Name (Legal Business Name): KRISTIN NEELY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 19TH ST
COLUMBUS GA
31901-1528
US

IV. Provider business mailing address

610 19TH ST
COLUMBUS GA
31901-1528
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-7884
  • Fax: 833-944-2043
Mailing address:
  • Phone: 706-322-7884
  • Fax: 833-944-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN154447
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: