Provider Demographics
NPI:1629752605
Name:KELLY, JOBY GARRARD (CFNP)
Entity Type:Individual
Prefix:MR
First Name:JOBY
Middle Name:GARRARD
Last Name:KELLY
Suffix:
Gender:M
Credentials:CFNP
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Mailing Address - Street 1:PO BOX 306415
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6415
Mailing Address - Country:US
Mailing Address - Phone:931-253-1110
Mailing Address - Fax:931-253-1190
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4091
Practice Address - Country:US
Practice Address - Phone:662-307-2884
Practice Address - Fax:662-307-2887
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS905988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily