Individual
KELLYE GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
171 LAKEWOOD DR, BATESVILLE, MS 38606-3011
(662) 655-0311
Mailing address
171 LAKEWOOD DR, BATESVILLE, MS 38606-3011
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901887
MS
Other
Enumeration date
12/28/2016
Last updated
12/28/2016
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