Provider Demographics
NPI:1487053070
Name:KELLETT, JENNIFER CAMERON (CLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAMERON
Last Name:KELLETT
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 GOODWYN GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2321
Mailing Address - Country:US
Mailing Address - Phone:901-490-7456
Mailing Address - Fax:
Practice Address - Street 1:3010 GOODWYN GREEN CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2321
Practice Address - Country:US
Practice Address - Phone:901-490-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN