Provider Demographics
NPI:1043190390
Name:MCKELVEY, JASON E (RN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:E
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26A COUNTY ROAD 271
Mailing Address - Street 2:
Mailing Address - City:GLEN
Mailing Address - State:MS
Mailing Address - Zip Code:38846-9799
Mailing Address - Country:US
Mailing Address - Phone:662-415-3242
Mailing Address - Fax:
Practice Address - Street 1:26A COUNTY ROAD 271
Practice Address - Street 2:
Practice Address - City:GLEN
Practice Address - State:MS
Practice Address - Zip Code:38846-9799
Practice Address - Country:US
Practice Address - Phone:662-415-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS909934163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty