Healthcare Provider Details

I. General information

NPI: 1184171423
Provider Name (Legal Business Name): KELSEY LONG SYKES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2016
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CYNTHIA ST
CLINTON MS
39056-3711
US

IV. Provider business mailing address

115 CYNTHIA ST
CLINTON MS
39056-3711
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-4444
  • Fax: 601-924-5471
Mailing address:
  • Phone: 601-924-4444
  • Fax: 601-924-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number992
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3673
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: