Kelly, Penny

Kelly, Penny is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Kelly, Penny can be contacted via phone (601) 984-5650.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 984-5650
Fax: (601) 984-5658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X R864313 Mississippi

Profile Details

NPI number 1598191298
LBN Legal business name Kelly, Penny
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2013
Last updated Mar 26th, 2020 - about 5 years 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 1598191298 NPPES
Mississippi MEDICAID 05824748

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