Individual
KELLY DENISE GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
105A QUALITY LN, SENATOBIA, MS 38668-2317
(662) 298-2144
Mailing address
3543 OLD CRENSHAW RD, CRENSHAW, MS 38621-5509
(662) 701-8063
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903082
MS
Other
Enumeration date
12/27/2018
Last updated
11/13/2022
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