Healthcare Provider Details

I. General information

NPI: 1073010948
Provider Name (Legal Business Name): KELLEE NICOLE NEAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 FARAON ST STE 160
SAINT JOSEPH MO
64506-3829
US

IV. Provider business mailing address

5301 FARAON ST STE 160
SAINT JOSEPH MO
64506-3829
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-4840
  • Fax: 816-671-4845
Mailing address:
  • Phone: 816-671-4840
  • Fax: 816-671-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2019035149
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: