Individual
KELLY MATTHEW RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
971 LAKELAND DR, SUITE 202, JACKSON, MS 39216-4643
(601) 362-1990
Mailing address
971 LAKELAND DR, SUITE 202, JACKSON, MS 39216-4643
(601) 362-1990
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R885450
MS
Other
Enumeration date
01/07/2015
Last updated
01/07/2015
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