Individual
MRS. KELLY K LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 NORTH STATE ST, DEPARTMENT OF MEDICINE DIVISION OF GENERAL INTERNAL MED, JACKSON, MS 39216
(601) 984-5660
(601) 984-6870
Mailing address
2500 N STATE ST, DEPT OF MEDICINE, JACKSON, MS 39216-4500
(601) 984-5660
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R855212
MS
363L00000X
Nurse Practitioner
Primary
R855212
MS
363LF0000X
Family Nurse Practitioner
R855212
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0124222
—
MS
Enumeration date
06/04/2006
Last updated
04/10/2014
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