Provider Demographics
NPI:1053808592
Name:JABER, KELLYANNE SAOIRSE (LM, CPM)
Entity type:Individual
Prefix:
First Name:KELLYANNE
Middle Name:SAOIRSE
Last Name:JABER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SPRING STAR CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-7638
Mailing Address - Country:US
Mailing Address - Phone:727-967-0866
Mailing Address - Fax:
Practice Address - Street 1:7117 BLACHE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4868
Practice Address - Country:US
Practice Address - Phone:904-990-3619
Practice Address - Fax:904-562-3402
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW361176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife