Healthcare Provider Details

I. General information

NPI: 1285519447
Provider Name (Legal Business Name): MICHELLE CATHRYN NEELLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE THOMPSON

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S 70TH ST STE 203
LINCOLN NE
68510-4293
US

IV. Provider business mailing address

7836 GERALD AVE
LINCOLN NE
68516-7769
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-1101
  • Fax:
Mailing address:
  • Phone: 402-613-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3289
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: