Individual
KELLEY DEBAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 947-8181
(601) 947-4411
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-8181
(601) 947-4411
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R859003
MS
363LF0000X
Family Nurse Practitioner
Primary
R859003
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R859003
STATE LICENSURE
MS
Enumeration date
08/19/2014
Last updated
11/22/2016
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