Individual
KELLEY N MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
218 EAST MAIN STREET, FLORENCE, MS 39073
(601) 845-6602
(601) 845-6164
Mailing address
PO BOX 530, FLORENCE, MS 39073-0530
(601) 845-6602
(601) 845-6164
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R814098
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122896
—
MS
Enumeration date
10/03/2006
Last updated
02/22/2024
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