Provider Demographics
NPI:1144665316
Name:JARRETT, KELLI (MD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 N MARINE CORPS DR STE 121
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4426
Mailing Address - Country:US
Mailing Address - Phone:671-588-2394
Mailing Address - Fax:
Practice Address - Street 1:744 N MARINE CORPS DR STE 121
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4426
Practice Address - Country:US
Practice Address - Phone:671-588-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60633045207Q00000X
MTMED-PHYS-LIC-59169207Q00000X
390200000X
GUM-2417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program