Healthcare Provider Details

I. General information

NPI: 1902717283
Provider Name (Legal Business Name): KELLY ANN NEYLAN MBA, RM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY NEYLAN

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 TWIN KNOLLS RD STE 109
COLUMBIA MD
21045-3260
US

IV. Provider business mailing address

5501 TWIN KNOLLS RD STE 109
COLUMBIA MD
21045-3260
US

V. Phone/Fax

Practice location:
  • Phone: 410-442-6650
  • Fax:
Mailing address:
  • Phone: 410-442-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: