Individual provider Active NPI

Amelia Margaret Kelley, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, MS
National Provider Identifier
1780068056
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R885361 Issued in MS
Practice address
1415 College Dr
Meridian, MS 39307-5345
Phone
(601) 483-4821
NPI assigned
Jul 16, 2015
Last updated
Mar 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R885361 MS Primary

Addresses

Primary practice location

1415 College Dr
Meridian, MS 39307-5345

Mailing address

2372 Sims Rd
Louisville, MS 39339-6826
Phone (662) 803-0379

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150807014698 MS Practitioner - Nurse Practitioner 2062726789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Region Ten State of MsGroup PAC ID 4284605353, 13 clinicians

Practice addresses (Care Compare)

1415 College Dr
Meridian, MS 39307-5345
Phone 6014834821125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R885361MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Region Ten Commission State of Ms CurrentSince Jul 16, 2015 Accepting new patients

Locations

1415 College Dr
Meridian, MS 39307
Phone (601) 483-4821

Interoperability endpoints

  • Direct secure messaging: amelia.kelley.1@15070.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1780068056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2372 SIMS RD",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393396826",
            "telephone_number": "662-803-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 COLLEGE DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393075345",
            "telephone_number": "601-483-4821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "AMELIA",
        "middle_name": "MARGARET",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-16",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "R885361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.