Individual
JENNIFER LYNNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
2101 CORONA RD STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
(573) 234-1799
Mailing address
2101 CORONA RD STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2009019364
MO
363LF0000X
Family Nurse Practitioner
2020003607
MO
363LG0600X
Gerontology Nurse Practitioner
Primary
2020003607
MO
Other
Enumeration date
07/20/2020
Last updated
05/25/2021
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