Provider Demographics
NPI:1376089086
Name:KURTENBACH, KELSEY L (FNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:KURTENBACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:L
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1207 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3132
Mailing Address - Country:US
Mailing Address - Phone:734-968-5608
Mailing Address - Fax:
Practice Address - Street 1:27355 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3300
Practice Address - Country:US
Practice Address - Phone:734-968-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284772163W00000X
MI1376089086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse