Madison Kelly

Individual provider Active NPI Behavior Analyst · Gulfport, MS

NPI 1295596393 · NPPES record last updated Jul 20, 2026

Key facts

NPI
1295596393
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Analyst 103K00000X
License
261023 (MS)
Practice address
15489 Dedeaux Rd
Gulfport, MS 39503-2667
Phone
(228) 357-5671
Fax
(228) 357-5708
NPI assigned
Jan 17, 2024
Sex
Female
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Education Solutions Past
since Jan 21, 2024
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 261023 MS Yes
Behavior Technician 106S00000X

Addresses

Primary practice location

15489 Dedeaux Rd
Gulfport, MS 39503-2667

Mailing address

15489 Dedeaux Rd
Gulfport, MS 39503-2667
Phone (228) 357-5671

Other providers in Gulfport, MS

All providers in Gulfport, MS · Behavior Analyst in Mississippi

Sources for this page

Verify at the official NPI Registry.