Individual
DR. KENNETH W KELLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 N STATE ST, CLARKSDALE, MS 38614-6519
(662) 621-2192
(662) 621-2314
Mailing address
705 N STATE ST, CLARKSDALE, MS 38614-6519
(662) 621-2192
(662) 621-2314
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16776
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121009
—
MS
Enumeration date
06/04/2006
Last updated
12/03/2009
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