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1306868708
KELLIE SMITH LANE
JACKSON, MS
NPI
1306868708
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Former Name
KELLIE SMITH BUTLER
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MS R865577)
Enumeration Date
2006-07-24
Last Update Date
2017-01-05
Business Address
Mrs. KELLIE SMITH LANE
3502 W NORTHSIDE DR
JACKSON, MS 39213-4454
Phone number: 601-362-5321
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Mailing Address
Mrs. KELLIE SMITH LANE
3502 W NORTHSIDE DR
JACKSON, MS 39213-4454
Phone number: 601-362-5321
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