Provider Demographics
NPI:1003150392
Name:HOPE, KELLY L (RN, NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HOPE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30701 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0990
Mailing Address - Country:US
Mailing Address - Phone:248-737-4030
Mailing Address - Fax:248-307-7873
Practice Address - Street 1:30701 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0990
Practice Address - Country:US
Practice Address - Phone:248-737-4030
Practice Address - Fax:248-307-7873
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704264482363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care