Kevin Mark Connolly | Jackson, MS • PECOS Search

Kevin Mark Connolly

Psychologist

Behavioral Health & Social Service Providers

1500 E Woodrow Wilson Ave, (116a2), Jackson, MS 39216-5116

PECOS Enrollment

Based on the most recent information from CMS, provider Kevin Mark Connolly does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1821229360
Provider Type
Individual
Full Name
Connolly, Kevin Mark
Title
Dr.
Credential
PH.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
7/31/2009
Last Updated
8/19/2013

Contact Information

Practice Location

1500 E Woodrow Wilson Ave, (116a2), Jackson, MS 39216-5116

Unlisted Fax

Mailing Location

1500 E Woodrow Wilson Ave, (116a2), Jackson, MS 39216-5116

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License 49845 Mississippi