Individual
JENNIFER KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3841 RUCKRIEGEL PKWY, LOUISVILLE, KY 40299-3986
(502) 791-8700
(502) 742-8523
Mailing address
600 CROSS POINTE RD, SUITE A, GAHANNA, OH 43230-6696
(513) 725-2186
(614) 577-1427
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3008785
KY
363LG0600X
Gerontology Nurse Practitioner
3008785
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100365330
—
KY
Enumeration date
09/23/2014
Last updated
10/23/2020
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