Provider Demographics
NPI:1083815450
Name:KELLY, JAYME E (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:MISS
Other - First Name:JAYME
Other - Middle Name:ELIZABETH
Other - Last Name:AYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-1526
Mailing Address - Country:US
Mailing Address - Phone:859-468-1780
Mailing Address - Fax:317-968-1485
Practice Address - Street 1:416 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1526
Practice Address - Country:US
Practice Address - Phone:859-468-1780
Practice Address - Fax:317-968-1485
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12313363LF0000X
KYARNP 5095P363LP0808X
OHCOA.12313.NP363LP0808X
NV832428364SP0810X
IN71003051A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846611Medicaid
9345631Medicare UPIN