Provider Demographics
NPI:1437145166
Name:KELSON, JENNISE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNISE
Middle Name:M
Last Name:KELSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4358 LOCHSA LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1739
Mailing Address - Country:US
Mailing Address - Phone:678-889-4862
Mailing Address - Fax:678-889-4862
Practice Address - Street 1:5671 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 680
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:770-722-5786
Practice Address - Fax:770-722-5786
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN112685367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered