MARY KELLEY INC (NPI# 1770761728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770761728 |
| Entity Type | Organization |
| Organization Name | MARY KELLEY INC |
| Practice Address |
1901 Mission 66 Vicksburg MS 39180 |
| Practice Telephone | 6016360097 |
| Practice Fax Number | 6016299969 |
| Mailing Telephone | 6016360097 |
| Mailing Fax Number | 6016299969 |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2008-06-12 |
| Authorized Official Name | CECELIA M JOURDAN (PRES/NP) |
| Authorized Official Telephone | 6016360097 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SF0001X |
Clinical Nurse Specialist Specialization: Family Health |
R642193 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 03575561 | 05 |
| Street Address |
1901 MISSION 66 |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023087855 | Good Samaritan Physical Therapy,inc. | Durable Medical Equipment & Medical Supplies | 1901 Mission 66, Suite A, Vicksburg, MS 39180-3711 | 2006-03-15 |
| 1922633916 | Physician Management Services of Mississippi, LLC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2020-03-10 |
| 1417410911 | Cal-med LLC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2019-04-11 |
| 1174067250 | Robert M Cannon Md LLC | Clinic/Center | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2016-12-08 |
| 1659739787 | Denesia Y Giffin Pllc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2016-02-03 |
| 1710351572 | Alliance Healthcare Services Inc | Clinic/Center | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2015-11-17 |
| 1588078737 | Christina Hossley Inc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2014-06-16 |
| 1639597966 | K Mcdaniel Inc | Nurse Practitioner | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2014-04-03 |
| 1215373139 | Robert Michael Cannon | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2013-05-18 |
| 1326289612 | J Russell Barnes Md PC | Family Medicine | 1901 Mission 66, Vicksburg, MS 39180-3711 | 2009-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 364SF0001X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Family Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689067324 | Kimaka Bowens | Clinical Nurse Specialist | 14 Maroon Dr, Picayune, MS 39466-8049 | 2015-03-05 |
| 1386949501 | Health Care Plus | Clinical Nurse Specialist | 305 N 2nd St, Booneville, MS 38829-2029 | 2011-01-19 |
| 1285815548 | Sandra J Bonom | Clinical Nurse Specialist | 126 Pine Ridge Cir, Brandon, MS 39047-7514 | 2007-11-15 |
| 1134523111 | Carli Crapps | Clinical Nurse Specialist | 2500 North State Street, Jackson, MS 39216 | 2014-10-20 |
| 1154722569 | Christine Haynes Roberts | Clinical Nurse Specialist | 2500 North State Street, Jackson, MS 39216-4500 | 2014-09-05 |
| 1477706323 | Heather Gilmer | Clinical Nurse Specialist | 566 E Main St, Louisville, MS 39339-2742 | 2008-10-23 |
Please comment or provide details below to improve the information on MARY KELLEY INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.