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Individual
BOBBIE N JELLISON
Active
Individual
BOBBIE N JELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01079671A
IN
207Q00000X
Family Medicine Physician
MD2013-0927
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23138581
—
NM
01
—
342812YLNY
MEDICARE PTAN
NM
01
—
MD2013-0927
LICENSE
NM
01
—
Q00288124
RAILROAD MEDICARE
IN
Enumeration date
05/10/2010
Last updated
07/08/2022
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