Doctor Name: | JESSICA LYNN KELLEY |
NPI Number: | 1043526403 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | R198081-5 |
Business Practice Address: | 820 2nd Ave N Windom, MN - 561011761 |
Business Phone Number: | 5078318405 |
Business Fax Number: | 5078315668 |
Mailing Address: | Po Box 338, WINDOM |
State: | MN |
Postal Code: | 561010338 |
Phone Number: | 5078318405 |
Fax Number: | 5078314668 |
NPI Enumeration Date: | 08/24/2010 |
NPI Last Update Date: | 08/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R198081-5 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |