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NPI Code Detail

MEDICARE: KELLY SHOWS

MEDICARE: KELLY SHOWS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistS2465MS

General Provider Information

NPI Number : 1366656548
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SHOWS
Provider Business Mailing Address
First Line : 250 PITTMAN RD
Second Line :
City : MOSELLE
State : MS
Zip : 39459-8801
Country : US
Telephone Number : 601-250-4815
Fax Number : 601-250-6859
Provider Business Practice Location Address
First Line : 206 MARYLAND AVE
Second Line :
City : MCCOMB
State : MS
Zip : 39648-3926
Country : US
Telephone Number : 601-250-4815
Fax Number : 601-250-6859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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Directions to “ KELLY SHOWS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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