# KELLONTREIA LAPORCHE JACKSON

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

## Provider details

- **NPI number:** 1619685534
- **Gender:** F
- **Credential:** A-GNP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NP259383 | GA | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | 1176633 | TX | — |
| 363LG0600X | Gerontology Nurse Practitioner | 36993 | TN | — |
| 363LG0600X | Gerontology Nurse Practitioner | 4704420181 | MI | — |
| 363LG0600X | Gerontology Nurse Practitioner | C-APN.0102805-C-NP | CO | — |
| 363LG0600X | Gerontology Nurse Practitioner | H181146 | IA | — |
| 363LG0600X | Gerontology Nurse Practitioner | NP259383 | GA | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | RN259383 | GA | Yes |

## Other

- **Enumeration date:** 11/09/2022
- **Last updated:** 05/13/2026