Healthcare Provider Details

I. General information

NPI: 1417676859
Provider Name (Legal Business Name): GILBERT L NEELY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 TUCKER RD
PLEASANTON KS
66075-8401
US

IV. Provider business mailing address

PO BOX 1832
PITTSBURG KS
66762-1832
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-9170
  • Fax: 913-352-8998
Mailing address:
  • Phone: 888-777-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81337-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: