Provider Demographics
NPI:1316403504
Name:CHRISTIE, KELLI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:BRUNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2798 W NORTH UNION RD APT 73
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9294
Mailing Address - Country:US
Mailing Address - Phone:616-745-7018
Mailing Address - Fax:
Practice Address - Street 1:4 COLUMBUS AVE STE 140
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6469
Practice Address - Country:US
Practice Address - Phone:989-393-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant