Keeley Gardner, CSS
Individual provider Active NPI Counselor · Purvis, MS
NPI 1558083188 · NPPES record last updated Sep 12, 2022
Key facts
- NPI
- 1558083188
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 3684 (MS)
- Practice address
- 805 Highway 589
Purvis, MS 39475-4194 - Phone
- (601) 794-6543
- Fax
- (601) 794-2455
- NPI assigned
- Sep 12, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3684 | MS | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 3684 | MS | Yes |
Addresses
Primary practice location
805 Highway 589
Purvis, MS 39475-4194
Mailing address
PO Box 18679
Hattiesburg, MS 39404-8679
Phone (601) 705-1901
Other providers in Purvis, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.