Individual
KELLY NICOLE TULLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1440 JEFFERSON ST, LAUREL, MS 39440-4243
(601) 428-0577
(601) 426-9854
Mailing address
PO BOX 247, LAUREL, MS 39441-0247
(601) 477-8553
(601) 477-9158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23841
MS
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
23841
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2012
Last updated
08/22/2023
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