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Contact Information

MARY KELLEY INC
1901 MISSION 66
VICKSBURG, MS39180
 Phone: 601-636-0097
 Fax: 601-629-9969
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Health

364SF0001X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for MARY KELLEY INC · (Female)

NPI Number 1770761728
Status Active
Credentials
Entity Individual
Enumeration date 02/01/2008
Last updated 06/12/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS License # R642193
  • MS Medicaid 03575561
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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