Provider Demographics
NPI:1043804735
Name:MORGAN, KELLY ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9379 LIBERTY CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3496
Mailing Address - Country:US
Mailing Address - Phone:734-751-8744
Mailing Address - Fax:
Practice Address - Street 1:39500 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2947
Practice Address - Country:US
Practice Address - Phone:248-476-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily