Provider Demographics
NPI:1225661267
Name:THOMAS, MICHELLE KELLI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KELLI
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KELLI
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:48221 FARAH DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2010
Mailing Address - Country:US
Mailing Address - Phone:586-350-9304
Mailing Address - Fax:
Practice Address - Street 1:48221 FARAH DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2010
Practice Address - Country:US
Practice Address - Phone:586-350-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704302721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily