Provider Demographics
NPI:1043831910
Name:QUAY, KERRILY (RN,MSN,ACAGNP-BC)
Entity Type:Individual
Prefix:
First Name:KERRILY
Middle Name:
Last Name:QUAY
Suffix:
Gender:F
Credentials:RN,MSN,ACAGNP-BC
Other - Prefix:
Other - First Name:KERRILY
Other - Middle Name:
Other - Last Name:COPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,MSN,ACAGNP-BC
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33155 ANNAPOLIS ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-467-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271971363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care