Provider Demographics
NPI:1639477425
Name:ELY, MARY CAY BROOKS (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CAY BROOKS
Last Name:ELY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-0520
Mailing Address - Country:US
Mailing Address - Phone:601-646-7700
Mailing Address - Fax:888-735-7202
Practice Address - Street 1:213 N PEARMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2633
Practice Address - Country:US
Practice Address - Phone:662-588-3911
Practice Address - Fax:949-561-4976
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS766681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner