Jackley, Jenell Diane

Jackley, Jenell Diane is an sole proprietor health care provider with primary practice located at 4006 Washington Rd , Kenosha WI 53144-4819. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Jackley, Jenell Diane can be contacted via phone (262) 656-0044.

Contact Information

Primary practice address
4006 Washington Rd Kenosha WI 53144-4819
Phone: (262) 656-0044
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 041.389592 Illinois
Nursing Service Providers / Registered Nurse 163W00000X 163094-030 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 209.010138 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 12260-33 Wisconsin

Profile Details

NPI number 1942502612
LBN Legal business name Jackley, Jenell Diane
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 30th, 2010
Last updated Sep 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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