Individual
KELLY L DONNELL-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, APN-C
Contact information
Practice address
1015 BRIGGS RD, MOUNT LAUREL, NJ 08054-4115
(856) 727-0900
(856) 231-8428
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 355-0340
(856) 355-0330
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR09192400
NJ
363L00000X
Nurse Practitioner
SP010454
PA
363LF0000X
Family Nurse Practitioner
Primary
26NJ00060400
NJ
Other
Enumeration date
06/19/2007
Last updated
10/20/2020
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