Provider Demographics
NPI:1508460841
Name:MCKELL, JENTRY CORA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JENTRY
Middle Name:CORA
Last Name:MCKELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENTRY
Other - Middle Name:CORA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1664 S DIXIE DR STE E102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7329
Mailing Address - Country:US
Mailing Address - Phone:435-703-9647
Mailing Address - Fax:435-703-6003
Practice Address - Street 1:691 E 400 N STE 110
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-7509
Practice Address - Country:US
Practice Address - Phone:385-203-0246
Practice Address - Fax:385-203-0245
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7684329-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily