Individual provider · Type 1 NPI
Kellontreia Laporche Jackson, A-GNP-C
Gerontology Nurse Practitioner · Hawkinsville, GA
NPI number
1619685534
Active
Practice location
37 341 Byp
Hawkinsville, GA 31036-4839
Mailing address
4196 Highway 62 412 Ste A
Hardy, AR 72542-8002
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 4704420181 (MI) |
| Gerontology Nurse Practitioner Primary | 363LG0600X | NP259383 (GA) |
| Gerontology Nurse Practitioner | 363LG0600X | 1176633 (TX) |
| Gerontology Nurse Practitioner | 363LG0600X | H181146 (IA) |
| Gerontology Nurse Practitioner | 363LG0600X | C-APN.0102805-C-NP (CO) |
| Gerontology Nurse Practitioner | 363LG0600X | 36993 (TN) |
Gerontology Nurse Practitioner: Definition to come...
2 other providers at this address
About NPI 1619685534
Kellontreia Laporche Jackson, A-GNP-C's National Provider Identifier is 1619685534, issued on Nov 9, 2022. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Hawkinsville, GA. The record was last updated on May 13, 2026.