MEDICARE: KELLY JEAN JAMESON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1790121614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JEAN JAMESON

Provider Business Mailing Address
First Line	:	361 ROBY LN
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-9550
Country	:	US
Telephone Number	:	270-256-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 ROBY LN
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-9550
Country	:	US
Telephone Number	:	270-256-9211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2013
Last Update Date	:	01/21/2026

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Directions to “ KELLY JEAN JAMESON ” Practice Location

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