Individual
HEATHER KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5888
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
905475
MS
Other
Enumeration date
10/17/2022
Last updated
06/12/2023
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