Organization
MARY KELLEY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECELIA M JOURDAN (PRES/NP)
(601) 636-0097
Entity
Organization
Contact information
Practice address
1901 MISSION 66, VICKSBURG, MS 39180
(601) 636-0097
(601) 629-9969
Mailing address
1901 MISSION 66, VICKSBURG, MS 39180
(601) 636-0097
(601) 629-9969
Taxonomy
Speciality
Code
Description
License number
State
364SF0001X
Family Health Clinical Nurse Specialist
Primary
R642193
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03575561
—
MS
Enumeration date
02/01/2008
Last updated
06/12/2008
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