# BOBBIE N JELLISON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023336443
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01079671A | IN | Yes |
| 207Q00000X | Family Medicine Physician | MD2013-0927 | NM | — |

## Other

- **Enumeration date:** 05/10/2010
- **Last updated:** 07/08/2022

## 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 |