Individual
KELLI S FEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
610 3RD ST SW, MAGEE, MS 39111-3994
(601) 439-7221
(601) 721-1773
Mailing address
610 3RD ST SW, MAGEE, MS 39111-3994
(601) 439-7221
(601) 721-1773
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R879688
MS
363LN0000X
Neonatal Nurse Practitioner
R879688
MS
363LN0005X
Critical Care Neonatal Nurse Practitioner
R879688
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004038362
—
MS
05
—
04038362
—
MS
Enumeration date
06/21/2012
Last updated
05/23/2024
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