Healthcare Provider Details

I. General information

NPI: 1841681558
Provider Name (Legal Business Name): TAMARA NEELY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 MORRIS PARK DR STE 14
MINT HILL NC
28227-8253
US

IV. Provider business mailing address

13048 ODELL HEIGHTS DR
MINT HILL NC
28227-4388
US

V. Phone/Fax

Practice location:
  • Phone: 704-335-8488
  • Fax:
Mailing address:
  • Phone: 704-724-7041
  • Fax: 704-625-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF0914874
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2018077349
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: