Provider Demographics
NPI:1407336423
Name:TINSON, KELLY LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:TINSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 BARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-0400
Mailing Address - Country:US
Mailing Address - Phone:228-219-0498
Mailing Address - Fax:
Practice Address - Street 1:1025 DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2910
Practice Address - Country:US
Practice Address - Phone:228-388-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily