Individual
MRS. KEITHA ANN JACELLARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
1335 E REPUBLIC RD, SPRINGFIELD, MO 65804-7248
(417) 363-3900
(417) 313-9998
Mailing address
PO BOX 2452, MOUNTAIN VIEW, AR 72560-2452
(870) 615-0825
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A004137
AR
Other
Enumeration date
09/12/2014
Last updated
05/31/2023
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