Provider Demographics
NPI:1386196277
Name:DAY, KELLY (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GOLF COURSE DR STE M
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-9037
Mailing Address - Country:US
Mailing Address - Phone:769-242-3185
Mailing Address - Fax:769-242-0099
Practice Address - Street 1:200 GOLF COURSE DR STE M
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-9037
Practice Address - Country:US
Practice Address - Phone:769-242-3185
Practice Address - Fax:769-242-0099
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner