MR. KELLY ROGER HERSEY M.D. NPI 1083641823

NPI Information

NPI: 1083641823
Provider Name: MR. KELLY ROGER HERSEY, M.D.
Classification: Pediatrics - 2080N0001X
Entity Type: Individual

Specialization: Neonatal-Perinatal Medicine

PECOS Registration: Yes

Address:
2500 N STATE ST
JACKSON, MS
ZIP 39216
Phone: (601) 815-7100
Get Directions

MR. Kelly Roger Hersey, M.D. is a neonatal-perinatal medicine pediatrics in Jackson, MS. The provider is a pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. MR. Kelly Roger Hersey, M.D. NPI is 1083641823. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2500 N STATE ST
JACKSON, MS
ZIP 39216-500
Phone: (601) 815-7100

The NPI 1083641823 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/27/2006 and was last updated on 6/27/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	15107	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	03439561	MEDICAID	MISSISSIPPI
2	302I375121	MEDICARE PIN	MISSISSIPPI
3	512I370075	MEDICARE PIN	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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