# KELLY D JENNE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1144767344
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 220320 | MT | Yes |
| 363LF0000X | Family Nurse Practitioner | 28209377A | IN | — |
| 363LF0000X | Family Nurse Practitioner | 71007550A | IN | — |

## Other

- **Enumeration date:** 01/25/2017
- **Last updated:** 10/08/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 068010568 | MEDICARE PTAN | IN |
| 01 | — | 090540375 | MEDICARE PTAN | IN |
| 05 | — | 300008240 | — | IN |
| 01 | — | P02474299 | RAILROAD PTAN | IN |