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General NPI Number Information
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NPI Number | 1255462230
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Entity Type | Individual
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Provider Name | GRACE PATRICIA KELLY MD
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 5003 POPLAR SPRINGS DR
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City | MERIDIAN
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State | MS
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Zip | 39305-1625
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Country | US
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Telephone | 601-453-5376
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Fax | 888-735-7202
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Provider Business Mailing Address
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Address Line | PO BOX 520
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City | MARION
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State | MS
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Zip | 39342-0520
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Country | US
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Telephone | 601-453-5393
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Fax | 601-581-9936
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MS11556
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License Number State | MS
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