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General NPI Number Information
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NPI Number | 1215677216
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Entity Type | Individual
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Provider Name | JENNIFER KELLY MSN, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 500 W MONROE ST STE 1300
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City | CHICAGO
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State | IL
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Zip | 60661-3704
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Country | US
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Telephone | 877-751-5783
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 MANATEE AVE W STE E
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City | BRADENTON
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State | FL
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Zip | 34205-4942
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Country | US
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Telephone | 941-744-0040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11018854
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License Number State | FL
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