Healthcare Provider Details

I. General information

NPI: 1518157221
Provider Name (Legal Business Name): KELLYE O JONES-HO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ANNAMARIE CT
WOOLWICH TOWNSHIP NJ
08085-3095
US

IV. Provider business mailing address

4 ANNAMARIE CT
WOOLWICH TOWNSHIP NJ
08085-3095
US

V. Phone/Fax

Practice location:
  • Phone: 856-467-2344
  • Fax:
Mailing address:
  • Phone: 856-467-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP009571
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00172900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN354634L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NR10373800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: