Individual
JENNY LYNN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-4060
(920) 288-4067
Mailing address
164 N BROADWAY, GREEN BAY, WI 54303-2728
(920) 965-4055
(920) 405-5388
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4936-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174872600
—
WI
Enumeration date
08/30/2012
Last updated
11/05/2013
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