KENNETH M KELLUM MD NPI 1508836032

NPI Information

NPI: 1508836032
Provider Name: KENNETH M KELLUM, MD
Classification: Internal Medicine - 207RN0300X
Entity Type: Individual

Specialization: Nephrology

Address:
1542 MEDICAL PARK CIR
TUPELO, MS
ZIP 38801
Phone: (662) 844-4711
Get Directions

Kenneth M Kellum, MD is a nephrology internal medicine in Tupelo, MS. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. Kenneth M Kellum, MD NPI is 1508836032. 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:

1542 MEDICAL PARK CIR
TUPELO, MS
ZIP 38801-560
Phone: (662) 844-4711
Fax: (662) 844-9619

The enumeration date for this NPI number is 1/26/2006 and was last updated on 6/30/2008.

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	207RN0300X	Internal Medicine	Nephrology	17130	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	Other Provider Identifier Issuer
1	0052650	OTHER		BLUE CROSS BLUE SHIELD
2	H35039	MEDICARE UPIN
3	73005462	OTHER		BLUE CROSS BLUE SHIELD
4	17130	OTHER		STATE LIC NUMBER
5	390000113	MEDICARE PIN	MISSISSIPPI
6	009970180	MEDICAID	ALABAMA
7	110221335	MEDICARE PIN	GEORGIA
8	640600391	OTHER		TAX ID NUMBER
9	00124083	MEDICAID	MISSISSIPPI
10	051555843	MEDICARE PIN	ALABAMA

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: 4/28/2024

NPI Synchronization or Removal

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