Individual
JENNIFER JO KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
3333 BURNET AVE, ML 5006 DIABETES CLINIC, CINCINNATI, OH 45229
(513) 636-9079
(513) 636-7576
Mailing address
3333 BURNET AVE, ML 5021, CINCINNATI, OH 45229-3039
(513) 636-9079
(513) 636-7576
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
COA.08014-NP
OH
363LP0200X
Pediatric Nurse Practitioner
COA.08014-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2656951
—
OH
Enumeration date
05/05/2006
Last updated
09/30/2012
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