Wilson, Kelly L

Wilson, Kelly L is an individual health care provider with primary practice located at 200 N Congress St Suite 100, Jackson MS 39201-1902. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Wilson, Kelly L can be contacted via phone (601) 355-8634.

Contact Information

Primary practice address
200 N Congress St Suite 100 Jackson MS 39201-1902
Phone: (601) 355-8634
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X C5370 Mississippi

Profile Details

NPI number 1275688137
LBN Legal business name Wilson, Kelly L
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2007
Last updated Sep 23rd, 2007 - about 19 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 1275688137 NPPES
Mississippi MEDICAID 08135705

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