Individual
MRS. KIMBERLY ANN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C
Contact information
Practice address
2164 SOUTHRIDGE DR, TUPELO, MS 38801-6417
(662) 760-0115
(662) 596-0428
Mailing address
238 COUNTY ROAD 2446, GUNTOWN, MS 38849-9106
(662) 760-0115
(662) 596-0428
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1923
MS
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
1923
MS
261QM1300X
Multi-Specialty Clinic/Center
Primary
1923
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001376867
—
MS
05
—
001437332
—
MS
05
—
01376867
—
MS
05
—
01437332
—
MS
01
—
83-4622726
COMMERCIAL
MS
05
—
83-4622726
—
MS
Enumeration date
02/17/2009
Last updated
01/29/2025
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