Provider Demographics
NPI:1396252011
Name:KELLY, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-3601
Mailing Address - Country:US
Mailing Address - Phone:601-267-4562
Mailing Address - Fax:601-267-4589
Practice Address - Street 1:1071 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-3601
Practice Address - Country:US
Practice Address - Phone:601-267-4562
Practice Address - Fax:601-267-4589
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF12170203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily