Provider Demographics
NPI:1457131930
Name:HOSKINS, KELLY ERVIN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ERVIN
Last Name:HOSKINS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-3702
Mailing Address - Country:US
Mailing Address - Phone:601-393-1953
Mailing Address - Fax:601-393-1954
Practice Address - Street 1:314 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-3702
Practice Address - Country:US
Practice Address - Phone:601-393-1953
Practice Address - Fax:601-393-1954
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS879928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty