Provider Demographics
NPI:1275086886
Name:JEAN-LOUIS, KELLY EILEEN (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:EILEEN
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 BARBADOS LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5400
Mailing Address - Country:US
Mailing Address - Phone:407-269-4935
Mailing Address - Fax:
Practice Address - Street 1:4805 BARBADOS LOOP
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5400
Practice Address - Country:US
Practice Address - Phone:407-269-4935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9301051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily