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General NPI Number Information
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NPI Number | 1972259505
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Entity Type | Individual
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Provider Name | JACQUELINE ANN KELLY RN
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Gender | Female
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 206 3RD ST NW
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City | MOHALL
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State | ND
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Zip | 58761-4105
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Country | US
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Telephone | 306-540-7407
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 811
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City | MOHALL
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State | ND
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Zip | 58761-0811
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Country | US
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Telephone | 306-540-7407
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 33918
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License Number State | ZZ
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