Individual
MICOLE NEELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, PA-C
Contact information
Practice address
702 W CAMELBACK RD STE 20, PHOENIX, AZ 85013-2291
(602) 845-5950
Mailing address
PO BOX 65223, PHOENIX, AZ 85082-5223
(602) 689-2349
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3679
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3679
AZ LICENSE
AZ
05
—
409214
—
AZ
Enumeration date
09/14/2007
Last updated
05/09/2025
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