Healthcare Provider Details

I. General information

NPI: 1275499204
Provider Name (Legal Business Name): KELLI DAWSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3573 HIGHWAY 24
LIBERTY MS
39645-8180
US

IV. Provider business mailing address

3573 HIGHWAY 24
LIBERTY MS
39645-8180
US

V. Phone/Fax

Practice location:
  • Phone: 601-341-7755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908053
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: