Individual
JACQUELINE MARY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
300 4TH ST, DANVILLE, WV 25053-4632
(304) 369-1230
Mailing address
271 FELLOWS AVE, SYRACUSE, NY 13210-2625
(315) 877-8055
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
381614
NY
Other
Enumeration date
10/25/2021
Last updated
07/29/2024
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