Individual
MRS. KELLY PRINE ALEXANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-4466
(601) 200-3651
Mailing address
PO BOX 23457, JACKSON, MS 39225-3457
(601) 200-4466
(601) 200-3651
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
901619
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07356036
—
MS
01
—
542520YKHV
MEDICARE
MS
01
—
P01770661
RAILROAD MEDICARE
MS
Enumeration date
06/30/2016
Last updated
07/20/2020
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