KELLONTREIA LAPORCHE JACKSON

DECATUR, GA
NPI1619685534
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LG0600X Nurse Practitioner, Gerontology
(Licence: GA  RN259383)
Additional Taxonomies363LG0600X Nurse Practitioner, Gerontology
(Licence: TN  36993)
363LG0600X Nurse Practitioner, Gerontology
(Licence: TX  1176633)
363LG0600X Nurse Practitioner, Gerontology
(Licence: MI  4704420181)
363LG0600X Nurse Practitioner, Gerontology
(Licence: CO  C-APN.0102805-C-NP)
363LG0600X Nurse Practitioner, Gerontology
(Licence: IA  H181146)
Enumeration Date2022-11-09
Last Update Date2024-11-11
Business Address
KELLONTREIA LAPORCHE JACKSON A-GNP-C
2732 CANDLER RD
DECATUR, GA 30034-1410
Phone number: 470-444-3133
Mailing Address
KELLONTREIA LAPORCHE JACKSON A-GNP-C
PO BOX 740013
ATLANTA, GA 30374-0013
Phone number: 312-733-9730