Individual
MS. KELLIE DERAE CHESTNUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ITDS, M.A.E.
Contact information
Practice address
910 N JEFFERSON ST, JACKSONVILLE, FL 32209-6810
(270) 847-5723
Mailing address
910 N JEFFERSON ST, JACKSONVILLE, FL 32209-6810
(270) 847-5723
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/02/2006
Last updated
03/13/2019
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