Provider Demographics
NPI:1013449610
Name:JONES, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LOUISE
Other - Last Name:THELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6262 E JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-7634
Mailing Address - Country:US
Mailing Address - Phone:352-201-1799
Mailing Address - Fax:
Practice Address - Street 1:6262 E JOYCE LN
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-7634
Practice Address - Country:US
Practice Address - Phone:352-201-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker