Shenika Sharee Kelly

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MS3644-12 Issued in MS

Practice address

514 E Woodrow Wilson Ave Ste G
Jackson, MS 39216

Phone

(769) 572-4425

Fax

(844) 270-0967

NPI assigned

Mar 11, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
• MS PPO D-SNP
• TN PPO C-SNP
• AL HMO
• devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
• TN PPO
• MS PPO C-SNP
• AL HMO D-SNP
• devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
• LA PPO C-SNP
• MS PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kelly Family Dentistry

  • Dental Clinic/Center
  • Jackson, MS
  • NPI 1619338761
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527984000000",
    "number": "1013282961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 GREENFIELD RIDGE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390427023",
            "telephone_number": "601-672-6085",
            "fax_number": "844-270-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 E WOODROW WILSON AVE STE G",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "769-572-4425",
            "fax_number": "844-270-0967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHENIKA",
        "middle_name": "SHAREE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-11",
        "last_updated": "2018-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "MS3644-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mick Henry Kelly
• Morgan Kelly, MD
• Ophelia Kelly, L.P.C.
• Peggy L Kelly
• Penny Kelly, APRN
• Jeannie N Kelso, LCSW
• David Wayne Kelton, M.D.
• Kemet Health One LLC
• Ann Butler Kemp, MD
• Stephen F Kemp, MD

• General Practice Dentistry in Jackson, MS
• Providers in Jackson, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.