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General NPI Number Information
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NPI Number | 1598933616
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Entity Type | Organization
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Legal Business Name | GRACE P KELLY MD
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Dates
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Enumeration Date | 02/11/2008
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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 | 601-453-5393
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Fax | 888-735-7202
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Provider Business Mailing Address
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Address Line | 5000 HIGHWAY 39 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1021
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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 | OWNER
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Name | DR. GRACE PATRICIA KELLY
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Credential | MD
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Telephone | 601-453-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MS11556
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License Number State | MS
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