Provider Demographics
NPI:1144633678
Name:NEYLAND, KEDECIA
Entity type:Individual
Prefix:
First Name:KEDECIA
Middle Name:
Last Name:NEYLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8327
Mailing Address - Country:US
Mailing Address - Phone:501-580-1184
Mailing Address - Fax:
Practice Address - Street 1:402 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-8327
Practice Address - Country:US
Practice Address - Phone:501-580-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARN/AMedicaid