Provider Demographics
NPI:1467120113
Name:KELLY, JOY ALAINE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ALAINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 HAYDEN CT
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-7530
Mailing Address - Country:US
Mailing Address - Phone:734-780-5802
Mailing Address - Fax:
Practice Address - Street 1:3376 HAYDEN CT
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-7530
Practice Address - Country:US
Practice Address - Phone:734-780-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner