Healthcare Provider Details

I. General information

NPI: 1699083725
Provider Name (Legal Business Name): KELLY MARIE MCKEE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7213 S SIWELL RD
BYRAM MS
39272-9776
US

IV. Provider business mailing address

199 BROOKMOORE DRIVE
COLUMBUS MS
39705
US

V. Phone/Fax

Practice location:
  • Phone: 601-346-9191
  • Fax: 601-346-3044
Mailing address:
  • Phone: 662-327-6705
  • Fax: 662-327-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305203682
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5652
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: