Individual
KELLAN E ASHLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE STREET, CARDIOLOGY, JACKSON, MS 39216-4500
(601) 984-5678
(601) 984-5638
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5678
(601) 984-5638
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
18726
MS
207RC0000X
Cardiovascular Disease Physician
33296
AL
207RC0000X
Cardiovascular Disease Physician
57.011859
OH
207RI0011X
Interventional Cardiology Physician
Primary
18726
MS
207RI0011X
Interventional Cardiology Physician
33296
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04034504
—
MS
05
—
130850
—
AL
01
—
P01233203
RAILROAD MEDICARE
MS
Enumeration date
07/01/2006
Last updated
10/06/2020
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