Individual
JASON KEITH ELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15190 COMMUNITY RD STE 260, GULFPORT, MS 39503-3471
(228) 762-4483
(228) 762-3147
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
(228) 497-8869
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9048725
MS
Other
Enumeration date
09/10/2021
Last updated
05/02/2022
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