Provider Demographics
NPI:1952550576
Name:JANKOWSKY, KELLY B (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:JANKOWSKY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:B
Other - Last Name:WENDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4173
Mailing Address - Country:US
Mailing Address - Phone:715-847-2611
Mailing Address - Fax:715-847-2465
Practice Address - Street 1:500 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4173
Practice Address - Country:US
Practice Address - Phone:715-847-2611
Practice Address - Fax:715-847-2465
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3507-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner