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Organization

THE PEDZ CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLI FEWELL PNP-PC (PEDIATRIC NURSE PRACTITIONER)
(601) 439-7221
Entity
Organization

Contact information

Practice address
610 3RD ST SW, MAGEE, MS 39111-3994
(601) 439-7221
(601) 439-7193
Mailing address
610 3RD ST SW, MAGEE, MS 39111-3994
(601) 439-7221
(601) 439-7193

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R879688
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04038362
MS
05
1154684363
MS
Enumeration date
12/22/2017
Last updated
08/07/2019
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