Provider Demographics
NPI:1932530276
Name:KELLEY, JACQUELINE ANN (APRN, DNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 WEST 8TH STREET
Mailing Address - Street 2:MOUNT MARTY COLLEGE
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-668-1435
Mailing Address - Fax:
Practice Address - Street 1:1105 WEST 8TH STREET
Practice Address - Street 2:MOUNT MARTY COLLEGE
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-668-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000042363LP0200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health