Individual
KELLI A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
423 N 21ST ST, SUITE 100, CAMP HILL, PA 17011-2207
(717) 761-0930
(717) 761-0465
Mailing address
390 PICNIC RD, LYKENS, PA 17048-9069
(717) 761-0930
(717) 761-0465
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN274366
PA
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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