Kelsey Melane Dement
Individual provider Active NPI Family Nurse Practitioner · Caledonia, MS
NPI 1720856552 · NPPES record last updated Jul 25, 2025
Key facts
- NPI
- 1720856552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 906449 (MS)
- Practice address
- 39 South Street
Caledonia, MS 39740 - Phone
- (662) 356-1560
- Fax
- (662) 356-1569
- NPI assigned
- Dec 12, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Webster Urgent Care Caledonia LLC
Practice addresses (Care Compare)
39 S St
Caledonia, MS 39740-8590
Phone (662) 356-1560
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 |
|---|---|---|---|---|
| I20251007000335 | MS | Practitioner - Nurse Practitioner | 5597262758 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 912758 | MS | MD | Registered Nurse |
| 906449 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Webster Urgent Care Caledonia LLC | Current |
Accepting new patients | |
| Elite Care Family Medicine, LLC | Past |
Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/12573/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 912758 | MS | |
| Family Nurse Practitioner | 363LF0000X | 906449 | MS | Yes |
Addresses
Primary practice location
39 South Street
Caledonia, MS 39740
Mailing address
50228 Greenwood Springs Rd
Greenwood Springs, MS 38848-8747
Phone (662) 436-3039
Other providers in Caledonia, MS
- Caledonia Community Clinic, LLC
- Lee Vester Calvert Jr.
- Clark Drug Company, LLC
- Robert Justin Clark
- Kathryn Comer
- Fig Leaf, LLC
- Misty S Glasgow
- Golden Triangle Family Eye Care, PLLC
- Lisa Jordan Hudson
- Jrco, LLC
All providers in Caledonia, 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 Jul 25, 2025. 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.