Provider Demographics
NPI:1790296960
Name:CAUSEY, KIRSTIN KELLAR (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:KELLAR
Last Name:CAUSEY
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 1:878 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4644
Mailing Address - Country:US
Mailing Address - Phone:601-984-5770
Mailing Address - Fax:601-984-6870
Practice Address - Street 1:878 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4644
Practice Address - Country:US
Practice Address - Phone:601-984-5770
Practice Address - Fax:601-984-6870
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily