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2164 Southridge Dr Tupelo MS 38801-6417 | |
| (660) 760-0115 | |
| (662) 596-0428 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2164 Southridge Dr, Tupelo, Mississippi |
| Authorized Official Name and Position | Kimberly A, Kelly (OWNER/PROVIDER) |
| Authorized Official Contact | 6627600115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
238 County Road 2446 Guntown MS 38849-9106 Ph: (662) 760-0115 | 2164 Southridge Dr Tupelo MS 38801-6417 Ph: (660) 760-0115 |
| NPI Number | 1033510391 |
|---|---|
| Provider Enumeration Date | 09/05/2014 |
| Last Update Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033510391 | NPI | - | NPPES |
| 1923 | Other | MS | COUNSELOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1923 (Mississippi) | Primary |
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