Provider Demographics
NPI:1659191864
Name:KELLY, JAZZOLYNN KHALIYA (DNP, CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:JAZZOLYNN
Middle Name:KHALIYA
Last Name:KELLY
Suffix:
Gender:F
Credentials:DNP, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4809
Mailing Address - Country:US
Mailing Address - Phone:323-253-5368
Mailing Address - Fax:
Practice Address - Street 1:1753 CLARKSON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4809
Practice Address - Country:US
Practice Address - Phone:323-253-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR249163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily