Provider Demographics
NPI:1073393203
Name:JEMMOTT, KELLI EDNA (RN)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:EDNA
Last Name:JEMMOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 OLD ORCHARD LN # 61
Mailing Address - Street 2:
Mailing Address - City:EAST MARION
Mailing Address - State:NY
Mailing Address - Zip Code:11939-1649
Mailing Address - Country:US
Mailing Address - Phone:516-885-9443
Mailing Address - Fax:
Practice Address - Street 1:1295 OLD ORCHARD LN # 61
Practice Address - Street 2:
Practice Address - City:EAST MARION
Practice Address - State:NY
Practice Address - Zip Code:11939-1649
Practice Address - Country:US
Practice Address - Phone:516-885-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494563163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health