Provider Demographics
NPI:1356861751
Name:PERRELLA, NELLA JACKSON (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:NELLA
Middle Name:JACKSON
Last Name:PERRELLA
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:NELLA
Other - Middle Name:JEANNINE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:2883 MARKBREIT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2019
Mailing Address - Country:US
Mailing Address - Phone:770-301-4035
Mailing Address - Fax:
Practice Address - Street 1:606 BUTTERMILK PIKE
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223408363LF0000X
OHAPRN.CNP.022420363LF0000X
KY3012187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily