Provider Demographics
NPI:1841300274
Name:JONES, KELI SMITH (PNP)
Entity type:Individual
Prefix:MS
First Name:KELI
Middle Name:SMITH
Last Name:JONES
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KELI
Other - Middle Name:ANNETTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3209 TREETOP VIEW LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-5727
Mailing Address - Country:US
Mailing Address - Phone:919-961-1508
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300309363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000432Medicaid
P94300Medicare UPIN