KELLIE SMITH LANE

JACKSON, MS
NPI1306868708
Former NameKELLIE SMITH BUTLER
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: MS  R865577)
Enumeration Date2006-07-24
Last Update Date2017-01-05
Business Address
Mrs. KELLIE SMITH LANE
3502 W NORTHSIDE DR
JACKSON, MS 39213-4454
Phone number: 601-362-5321
Mailing Address
Mrs. KELLIE SMITH LANE
3502 W NORTHSIDE DR
JACKSON, MS 39213-4454
Phone number: 601-362-5321
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