Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP018764 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP018764 | PA |
NPI | 1063901577 |
---|---|
Provider Name | Kelly N Jones |
First Address | Philadelphia, PA 19107-1500 |
Second Address | Paoli, PA 19301-1648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1036726900004 | (05) | PA |