1083815450 NPI number — MRS. JAYME E KELLY APRN BC

Table of content: MRS. JAYME E KELLY APRN BC (NPI 1083815450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083815450 NPI number — MRS. JAYME E KELLY APRN BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLY
Provider First Name:
JAYME
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AYRES
Provider Other First Name:
JAYME
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083815450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 SUNNYSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47001-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-468-1780
Provider Business Mailing Address Fax Number:
317-968-1485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 SUNNYSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47001-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-468-1780
Provider Business Practice Location Address Fax Number:
317-968-1485
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN.CNP.12313 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: ARNP 5095P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: COA.12313.NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0810X , with the licence number: 832428 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: 71003051A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2846611 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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