Individual
KELSEY ELYCE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
971 LAKELAND DR STE 657, JACKSON, MS 39216-4608
(601) 200-2780
(601) 200-2788
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1331
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
R-10660
IA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
35449
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2016
Last updated
11/15/2025
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