Provider Demographics
NPI:1629320858
Name:JESTER, KELLY KAYE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAYE
Last Name:JESTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KAYE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1005 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4308
Mailing Address - Country:US
Mailing Address - Phone:870-935-1242
Mailing Address - Fax:870-934-0144
Practice Address - Street 1:1005 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4308
Practice Address - Country:US
Practice Address - Phone:870-935-1242
Practice Address - Fax:870-934-0144
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health