Healthcare Provider Details

I. General information

NPI: 1396252011
Provider Name (Legal Business Name): JANET KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 E FRANKLIN ST
CARTHAGE MS
39051-3601
US

IV. Provider business mailing address

1071 E FRANKLIN ST
CARTHAGE MS
39051-3601
US

V. Phone/Fax

Practice location:
  • Phone: 601-267-4562
  • Fax: 601-267-4589
Mailing address:
  • Phone: 601-267-4562
  • Fax: 601-267-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12170203
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: