Kimberly Ann Kelly, L.P.C

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

1923 Issued in MS

Practice address

2164 Southridge Dr
Tupelo, MS 38801-6417

Phone

(662) 760-0115

Fax

(662) 596-0428

NPI assigned

Feb 17, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Journey Resource Center LLC

  • Professional Counselor
  • Tupelo, MS
  • NPI 1033510391
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1992944870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 COUNTY ROAD 2446",
            "city": "GUNTOWN",
            "state": "MS",
            "postal_code": "388499106",
            "telephone_number": "662-760-0115",
            "fax_number": "662-596-0428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2164 SOUTHRIDGE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016417",
            "telephone_number": "662-760-0115",
            "fax_number": "662-596-0428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "238 County Road 2446",
            "address_purpose": "LOCATION",
            "city": "Guntown",
            "state": "MS",
            "postal_code": "388499106",
            "country_code": "US",
            "telephone_number": "662-760-0115",
            "fax_number": "662-596-0428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "L.P.C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-17",
        "last_updated": "2025-01-29",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MS",
            "license": "1923",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "1923",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MS",
            "license": "1923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01437332",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "83-4622726",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001437332",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83-4622726",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01376867",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001376867",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel H. Kellum, DDS
• Jason Kellum
• Mark J Kellum, MD
• Samantha Kellum, RBT
• Thomas N. Kellum, DDS
• Morgan Kelly
• Rhonda S Kelly, CRNA
• Brittney Danielle Kelton, FNP-C
• Ken Lippincott, M.D., P.a.
• Holly J Kendrick, NP

• Multi-Specialty Clinic/Center in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Multi-Specialty Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.