MEDICARE: KELLI R CHUNN ACNP

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
1	363LA2200X	Adult Health Nurse Practitioner	R762267	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00191926	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942287867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI R CHUNN ACNP

Provider Business Mailing Address
First Line	:	PO BOX 470
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-0470
Country	:	US
Telephone Number	:	662-773-6211
Fax Number	:	662-446-1039

Provider Business Practice Location Address
First Line	:	106 W MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2620
Country	:	US
Telephone Number	:	662-773-5704
Fax Number	:	662-773-9463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	04/04/2025

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