Provider Demographics
NPI:1003686726
Name:KELLY, JESSICA FRANCES (MED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FRANCES
Last Name:KELLY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5400
Mailing Address - Country:US
Mailing Address - Phone:516-776-4486
Mailing Address - Fax:
Practice Address - Street 1:292 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5400
Practice Address - Country:US
Practice Address - Phone:516-776-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist