Provider Demographics
NPI:1083344188
Name:MCKELLER, JOCELYNE (NP)
Entity Type:Individual
Prefix:
First Name:JOCELYNE
Middle Name:
Last Name:MCKELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 AUDUBON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1245
Mailing Address - Country:US
Mailing Address - Phone:781-587-2628
Mailing Address - Fax:
Practice Address - Street 1:107 AUDUBON RD STE 102
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1245
Practice Address - Country:US
Practice Address - Phone:781-587-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG05220087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health