Kellum, Kenneth M

Kellum, Kenneth M is an individual health care provider with primary practice located at 1542 Medical Park Cir , Tupelo MS 38801-6560. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Kellum, Kenneth M can be contacted via phone (662) 844-4711.

Contact Information

Primary practice address
1542 Medical Park Cir Tupelo MS 38801-6560
Phone: (662) 844-4711
Fax: (662) 844-9619
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 17130 Mississippi

Profile Details

NPI number 1508836032
LBN Legal business name Kellum, Kenneth M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Jun 30th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508836032 NPPES
Other 73005462 BLUE CROSS BLUE SHIELD
Other 17130 BLUE CROSS BLUE SHIELD
Other 0052650 BLUE CROSS BLUE SHIELD
MEDICAID 009970180 BLUE CROSS BLUE SHIELD
MEDICAID 00124083 BLUE CROSS BLUE SHIELD

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