Provider Demographics
NPI:1407244395
Name:KELLEY, JAMIE LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:WENDLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:212 E CENTRAL AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4502
Mailing Address - Country:US
Mailing Address - Phone:509-553-0565
Mailing Address - Fax:
Practice Address - Street 1:212 E CENTRAL AVE STE 360
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4502
Practice Address - Country:US
Practice Address - Phone:509-553-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR879610163W00000X, 363LF0000X
WARN61158154163W00000X
WAAP61158161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse