Provider Demographics
NPI:1447062211
Name:JACKSON, KELI NALU PATRICIA (PA-C)
Entity type:Individual
Prefix:
First Name:KELI
Middle Name:NALU PATRICIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BELLAIRE ST APT 437
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4968
Mailing Address - Country:US
Mailing Address - Phone:808-640-5444
Mailing Address - Fax:
Practice Address - Street 1:800 BELLAIRE ST APT 437
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4968
Practice Address - Country:US
Practice Address - Phone:808-640-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant