Individual
MRS. JACQUELINE A. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
750 EAST ADAMS STREET, SYRACUSE, NY 13210
(315) 464-5979
(315) 464-4761
Mailing address
251 SALINA MEADOWS PARKWAY, SUITE 100, SYRACUSE, NY 13212-4516
(315) 464-2000
(315) 464-2010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
348747
NY
363L00000X
Nurse Practitioner
5010974
NC
363LF0000X
Family Nurse Practitioner
348747
NY
Other
Enumeration date
06/17/2018
Last updated
03/14/2022
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