Provider Demographics
NPI:1891983011
Name:KELLEY, JENNIFER WENZ (RN, CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WENZ
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE.
Mailing Address - Street 2:MEDICAL STAFF SERVICES, ML 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-0356
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:3333 BURNET AVE.
Practice Address - Street 2:INFECTIOUS DISEASES ML 6014
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4578
Practice Address - Fax:513-636-4704
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09530-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics