Healthcare Provider Details

I. General information

NPI: 1154545366
Provider Name (Legal Business Name): CONNIE MCNEELY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 W 4TH ST
LEXINGTON KY
40508-1207
US

IV. Provider business mailing address

627 W 4TH ST
LEXINGTON KY
40508-1207
US

V. Phone/Fax

Practice location:
  • Phone: 859-246-7000
  • Fax: 859-246-7023
Mailing address:
  • Phone: 859-246-7000
  • Fax: 859-246-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3941S
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: