Individual
MRS. KALEY GRANT GROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R880078
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06770035
—
MS
Enumeration date
07/22/2011
Last updated
05/12/2015
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