Provider Demographics
NPI:1063901577
Name:JONES, KELLY N (CRNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4142
Mailing Address - Fax:
Practice Address - Street 1:2 INDUSTRIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1648
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-3902
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018764363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036726900004Medicaid