Provider Demographics
NPI:1366952178
Name:BAKER-NEEL, KELLY LYNN (FNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:BAKER-NEEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6844 N US HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:POLLOK
Mailing Address - State:TX
Mailing Address - Zip Code:75969-4548
Mailing Address - Country:US
Mailing Address - Phone:936-853-8830
Mailing Address - Fax:
Practice Address - Street 1:6844 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969-4548
Practice Address - Country:US
Practice Address - Phone:936-853-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily