Provider Demographics
NPI:1447805379
Name:NEAL, SUNNY (APRN)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CASSIDY AVE
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KY
Mailing Address - Zip Code:42411-9207
Mailing Address - Country:US
Mailing Address - Phone:270-545-3386
Mailing Address - Fax:866-554-1778
Practice Address - Street 1:700 CASSIDY AVE
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KY
Practice Address - Zip Code:42411-9207
Practice Address - Country:US
Practice Address - Phone:270-545-3386
Practice Address - Fax:866-554-1778
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013403363L00000X
IL209.019561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner