Kellontreia Laporche Jackson, A-GNP-C is a gerontology nurse practitioner in Decatur, GA. Kellontreia Laporche Jackson, A-GNP-C NPI is 1619685534. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a female.
The provider's business location address is:
2732 CANDLER RD
DECATUR, GA
ZIP 30034-410
Phone: (470) 444-3133
Fax: (470) 276-4051
The NPI 1619685534 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The enumeration date for this NPI number is 11/9/2022 and was last updated on 8/3/2023.