| Doctor Name: | KELLY C JENEI |
| NPI Number: | 1386992048 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 201242836RN |
| Business Practice Address: | 2 James Way 209 Pismo Beach, CA - 934494973 |
| Business Phone Number: | 8057737440 |
| Business Fax Number: | 8057737448 |
| Mailing Address: | 2 James Way, 209 PISMO BEACH |
| State: | CA |
| Postal Code: | 934494973 |
| Phone Number: | 8057737440 |
| Fax Number: | 8057737448 |
| NPI Enumeration Date: | 08/28/2012 |
| NPI Last Update Date: | 05/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 201242836RN |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |