Provider Demographics
NPI:1518546530
Name:JONES, KELLY LYNN (PMHNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6473 TREELINE LN
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-6254
Mailing Address - Country:US
Mailing Address - Phone:317-796-2716
Mailing Address - Fax:
Practice Address - Street 1:6473 TREELINE LN
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-6254
Practice Address - Country:US
Practice Address - Phone:317-796-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28133978A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health