Healthcare Provider Details

I. General information

NPI: 1477373942
Provider Name (Legal Business Name): KAYLA MARIE NEELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S PROCTOR ST
TACOMA WA
98405-2047
US

IV. Provider business mailing address

3911 66TH AVE NW
GIG HARBOR WA
98335-8415
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5937
  • Fax:
Mailing address:
  • Phone: 253-514-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN61601205
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: