Kelly, Kimberly Ann

Kelly, Kimberly Ann is an individual health care provider with primary practice located at 2164 Southridge Dr , Tupelo MS 38801-6417. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Kelly, Kimberly Ann can be contacted via phone (662) 760-0115.

Contact Information

Primary practice address
2164 Southridge Dr Tupelo MS 38801-6417
Phone: (662) 760-0115
Fax: (662) 596-0428
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 1923 Mississippi
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1992944870
LBN Legal business name Kelly, Kimberly Ann
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 17th, 2009
Last updated May 23rd, 2024 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992944870 NPPES
Mississippi MEDICAID 01437332
Mississippi MEDICAID 001376867
Mississippi MEDICAID 001437332
Mississippi MEDICAID 01376867
Mississippi MEDICAID 83-4622726
Mississippi Other 83-4622726

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