Provider Demographics
NPI:1073387759
Name:JANTZ, KELSEY ANN
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:ANN
Last Name:JANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:JANTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2861 COPPERGROVE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3170
Mailing Address - Country:US
Mailing Address - Phone:616-901-8564
Mailing Address - Fax:
Practice Address - Street 1:2861 COPPERGROVE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-3170
Practice Address - Country:US
Practice Address - Phone:616-901-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704358989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily