Individual
MRS. KELLY JO EASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 E 3RD ST, BLOOMINGTON, IN 47401-5433
(812) 332-1419
Mailing address
3169 S BRAND LEE WAY, YUMA, AZ 85365-5110
(740) 260-0642
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71010029A
IN
Other
Enumeration date
05/09/2020
Last updated
05/09/2020
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