Provider Demographics
NPI:1295492437
Name:MISS-LOU GI PLLC
Entity type:Organization
Organization Name:MISS-LOU GI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:JEX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-597-4449
Mailing Address - Street 1:136 JEFF DAVIS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-492-2224
Mailing Address - Fax:601-492-2231
Practice Address - Street 1:136 JEFF DAVIS BLVD
Practice Address - Street 2:STE B
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-492-2224
Practice Address - Fax:601-492-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03506041Medicaid
LA2390007Medicaid