Provider Demographics
NPI:1861149593
Name:NEELY TOTAL HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:NEELY TOTAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARNITA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:972-217-5620
Mailing Address - Street 1:1510 N. HAMPTON RD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8301
Mailing Address - Country:US
Mailing Address - Phone:972-707-0113
Mailing Address - Fax:972-249-2057
Practice Address - Street 1:1510 N.HAMPTON RD.
Practice Address - Street 2:SUITE 220
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8301
Practice Address - Country:US
Practice Address - Phone:972-707-0113
Practice Address - Fax:972-249-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty