Mrs Kimberly Ann Kelly, LPC is a medicare enrolled "Clinic/center - Multi-specialty" provider in Tupelo, Mississippi. Her current practice location is
2164 Southridge Dr, Tupelo, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(662) 760-0115.
Mrs Kimberly Ann Kelly is licensed to practice in Mississippi (license number 1923) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1992944870.
Healthcare Provider's Profile
| Full Name | Mrs Kimberly Ann Kelly |
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| Gender | Female |
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| Speciality | Clinic/center - Multi-specialty |
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| Location | 2164 Southridge Dr, Tupelo, Mississippi |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1992944870
- Provider Enumeration Date: 02/17/2009
- Last Update Date: 01/29/2025
Medicare PECOS Information:
- PECOS PAC ID: 7416473749
- Enrollment ID: I20250429002835
Medical Identifiers
Medical identifiers for Mrs Kimberly Ann Kelly such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1992944870 | NPI | - | NPPES |
| 01437332 | Medicaid | MS | |
| 83-4622726 | Other | MS | COMMERCIAL |
| 001437332 | Medicaid | MS | |
| 83-4622726 | Medicaid | MS | |
| 01376867 | Medicaid | MS | |
| 001376867 | Medicaid | MS | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | 1923 (Mississippi) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | 1923 (Mississippi) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | 1923 (Mississippi) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Kimberly Ann Kelly allows following entities to bill medicare on her behalf.
| Entity Name | Journey Resource Center Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1033510391
PECOS PAC ID: 7618416892
Enrollment ID: O20250429002670 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Kimberly Ann Kelly is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Kimberly Ann Kelly, LPC
238 County Road 2446,
Guntown, MS 38849-9106
Ph: (662) 760-0115 | Mrs Kimberly Ann Kelly, LPC
2164 Southridge Dr,
Tupelo, MS 38801-6417
Ph: (662) 760-0115 |
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