Active NPI
Timothy Richard Kelly, MD
- Psychiatry Physician
- Oxford, MS
National Provider Identifier
1003026261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 17172
- Practice address
- 510 Azalea Dr Ste 200
Oxford, MS 38655-6903 - Phone
- (662) 236-6696
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 17172 | MS | Primary |
Addresses
Primary practice location
510 Azalea Dr Ste 200
Oxford, MS 38655-6903
Mailing address
438 County Road 471
Water Valley, MS 38965-3778
Phone (662) 281-0945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2012 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17172 | MS | MD | Psychiatry Physician |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/597f09fe-69bc-4621-95bd-45f5516bc666/
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003026261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "438 COUNTY ROAD 471",
"city": "WATER VALLEY",
"state": "MS",
"postal_code": "389653778",
"telephone_number": "662-281-0945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 AZALEA DR STE 200",
"city": "OXFORD",
"state": "MS",
"postal_code": "386556903",
"telephone_number": "662-236-6696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TIMOTHY",
"middle_name": "RICHARD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MS",
"license": "17172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxford, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.