Provider Demographics
NPI:1518742949
Name:LAIDLEY-KELLY, JENNIFER MARGARET (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARGARET
Last Name:LAIDLEY-KELLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 SIWANOY DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3436
Mailing Address - Country:US
Mailing Address - Phone:410-917-2792
Mailing Address - Fax:
Practice Address - Street 1:2963 SIWANOY DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3436
Practice Address - Country:US
Practice Address - Phone:410-917-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily