Healthcare Provider Details

I. General information

NPI: 1649182270
Provider Name (Legal Business Name): KALEY KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4996
US

IV. Provider business mailing address

141 ROUGH WOOD DR
PONTOTOC MS
38863-6109
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4239
  • Fax:
Mailing address:
  • Phone: 601-934-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-14356
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: