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Individual

DUSTIN KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
1117 SUNSET DR STE 101, GRENADA, MS 38901-4080
(662) 226-1168
Mailing address
2055 COUNTY ROAD 240, GREENWOOD, MS 38930-6995
(662) 299-5796

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
899168
MS
363LF0000X
Family Nurse Practitioner
Primary
906082
MS

Other

Enumeration date
07/04/2023
Last updated
07/04/2023
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