Provider Demographics
NPI:1588205173
Name:FELTY, K'LEE ANN
Entity Type:Individual
Prefix:
First Name:K'LEE
Middle Name:ANN
Last Name:FELTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9548
Mailing Address - Country:US
Mailing Address - Phone:731-792-5112
Mailing Address - Fax:
Practice Address - Street 1:3151 136TH AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9548
Practice Address - Country:US
Practice Address - Phone:731-792-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide