Provider Demographics
NPI:1952698532
Name:JEX, KELLEN TRAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:KELLEN
Middle Name:TRAVIS
Last Name:JEX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207975207R00000X, 207RG0100X
MS23270207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA656228OtherMEDICARE
MS1X4393OtherMEDICARE
LA2390007Medicaid
MS03506041Medicaid