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General NPI Number Information
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NPI Number | 1346607587
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Entity Type | Individual
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Provider Name | KIMBERLY R NEELY AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | ALTRU CANCER CENTER 960 S. COLUMBIA ROAD
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City | GRAND FORKS
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State | ND
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Zip | 58201-4036
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Country | US
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Telephone | 701-780-5000
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Fax | 304-781-5139
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Provider Business Mailing Address
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Address Line | PO BOX 13780
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City | GRAND FORKS
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State | ND
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Zip | 58208
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Country | US
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Telephone | 701-780-1891
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Fax | 304-697-2086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 201611
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 83344
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 201611
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 201611
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License Number State | ND
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