Elizabeth Brown Kelly, CFNP
Individual provider Active NPI Family Nurse Practitioner · Winona, MS
NPI 1144840489 · NPPES record last updated Apr 16, 2020
Key facts
- NPI
- 1144840489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 903768 (MS)
- Practice address
- 409 Tyler Holmes Dr
Winona, MS 38967-1521 - Phone
- (662) 283-4114
- Fax
- (662) 283-3288
- NPI assigned
- Apr 16, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Grenada Physician Services, LLC
Practice addresses (Care Compare)
960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7000
Hospital & facility affiliations
- University of Mississippi Medical Center- Grenada
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200930000684 | MS | Practitioner - Nurse Practitioner | 8729407432 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grenada Physician Services, LLC | Current |
Accepting new patients | |
| Tyler Holmes Memorial Hospital | Family | Current |
Accepting new patients |
| Tyler Holmes Memorial Hospital | Current |
Accepting new patients | |
| Kelly Health & Wellness Clinic LLC | Family | Past |
Accepting new patients |
Locations
960 Avent Dr
Grenada, MS 38901
Phone (662) 227-7000
409 Tyler Holmes Dr
Winona, MS 38967
Phone (662) 283-3060
700 Woodland Dr
Winona, MS 38967
Phone (662) 283-3060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 903768 | MS | Yes |
Addresses
Primary practice location
409 Tyler Holmes Dr
Winona, MS 38967-1521
Mailing address
409 Tyler Holmes Dr
Winona, MS 38967-1521
Phone (662) 283-4114
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | elizabeth.kelly@tylerholmes.cernerdirect.com |
Other providers in Winona, MS
- Veronica Johnson
- Jones Family Health Clinic, LLC
- Angela Jones
- Rochelle Reed Jordan
- Karts of Winona Pharmacy, LLC
- Kilmichael Medical Suppliers
- Kilmichael Medical Suppliers Inc
- Kilmichael Medical Supplies
- Aleighsha B King
- Jeremy S King
All providers in Winona, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.