Provider Demographics
NPI:1184844466
Name:GARRETT, KELLYE (APMHNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLYE
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:APMHNP
Other - Prefix:MRS
Other - First Name:KELLYE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APMHNP
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835
Mailing Address - Country:US
Mailing Address - Phone:662-286-9883
Mailing Address - Fax:662-284-9836
Practice Address - Street 1:2100 EAST CHAMBERS DRIVE
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829
Practice Address - Country:US
Practice Address - Phone:662-728-3174
Practice Address - Fax:662-728-3175
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855689363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR855689OtherLICENSE
MSR855689OtherLICENSE
MS500001798Medicare ID - Type Unspecified