Individual
KELSA SHIRLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
30 CIRCLE J DR STE 1, LAUREL, MS 39440-1981
(601) 425-0092
(601) 425-0473
Mailing address
30 CIRCLE J DR STE 1, LAUREL, MS 39440-1981
(601) 425-0092
(601) 425-0473
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901625
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
901625
MS LICENSE
MS
Enumeration date
07/16/2016
Last updated
10/02/2023
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