Individual
MRS. MARY KELLY RYALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
Mailing address
165 MEMORY LN, MADISON, MS 39110-6866
(601) 707-7705
(601) 707-7705
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R877106
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
271785YPC0
MEDICARE PTAN
—
Enumeration date
12/26/2012
Last updated
04/10/2013
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