Individual
STEVEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 575-2000
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 575-1740
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902094
MS
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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