Individual
KELLONTREIA LAPORCHE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A-GNP-C
Contact information
Practice address
37 341 BYP, HAWKINSVILLE, GA 31036-4839
(478) 845-4842
Mailing address
4196 HIGHWAY 62 412 STE A, HARDY, AR 72542-8002
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP259383
GA
363LG0600X
Gerontology Nurse Practitioner
1176633
TX
363LG0600X
Gerontology Nurse Practitioner
36993
TN
363LG0600X
Gerontology Nurse Practitioner
4704420181
MI
363LG0600X
Gerontology Nurse Practitioner
C-APN.0102805-C-NP
CO
363LG0600X
Gerontology Nurse Practitioner
H181146
IA
363LG0600X
Gerontology Nurse Practitioner
Primary
NP259383
GA
363LG0600X
Gerontology Nurse Practitioner
Primary
RN259383
GA
Other
Enumeration date
11/09/2022
Last updated
05/13/2026
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