Individual
KELLY R O'REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
Mailing address
220 JOHNSTONE DR., MADISON, MS 39110
(601) 707-7039
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
081436
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2179942
—
LA
01
—
P01629810
RAILROAD MEDICARE
MS
Enumeration date
06/25/2009
Last updated
05/11/2016
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