Provider Demographics
NPI:1487022091
Name:FERRELL, KEVIN E (PA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:FERRELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50973 COUNTY ROAD 681
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-9048
Mailing Address - Country:US
Mailing Address - Phone:517-898-7718
Mailing Address - Fax:269-639-2818
Practice Address - Street 1:50973 COUNTY ROAD 681
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MI
Practice Address - Zip Code:49064-9048
Practice Address - Country:US
Practice Address - Phone:269-241-2220
Practice Address - Fax:269-674-4239
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601007459OtherPHYSICIAN ASSISTANT TEMPORARY LICENSE