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General NPI Number Information
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NPI Number | 1720856552
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Entity Type | Individual
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Provider Name | KELSEY MELANE DEMENT
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 39 SOUTH STREET
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City | CALEDONIA
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State | MS
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Zip | 39740
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Country | US
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Telephone | 662-356-1560
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Fax | 662-356-1569
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Provider Business Mailing Address
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Address Line | 50228 GREENWOOD SPRINGS RD
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City | GREENWOOD SPRINGS
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State | MS
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Zip | 38848-8747
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Country | US
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Telephone | 662-436-3039
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 912758
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 906449
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License Number State | MS
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