MARY KELLEY INC NPI 1770761728

NPI Information

  • NPI: 1770761728
  • Provider Name: MARY KELLEY INC
  • Classification: Clinical Nurse Specialist - 364SF0001X
  • Specialization: Family Health
  • Entity Type: Organization
  • Address: 1901 MISSION 66
    VICKSBURG, MS
    ZIP 39180
  • Phone: (601) 636-0097

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NPI Details

MARY KELLEY INC is a family health clinical nurse specialist in Vicksburg, MS. MARY KELLEY INC NPI is 1770761728. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1901 MISSION 66
VICKSBURG, MS
ZIP 39180
Phone: (601) 636-0097
Fax: (601) 629-9969

The provider's authorized official is Cecelia M Jourdan .
The authorized official title is Pres/np and has the following contact phone number (601) 636-0097.

The enumeration date for this NPI number is 2/1/2008 and was last updated on 6/12/2008.

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
1364SF0001XClinical Nurse SpecialistFamily HealthR642193MISSISSIPPIYes

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
103575561MEDICAIDMISSISSIPPI
2S27978MEDICARE UPINMISSISSIPPI
3512G700184MEDICARE PINMISSISSIPPI

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: 11/21/2025

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