Provider Demographics
NPI:1598951915
Name:KELLEY, DUANE A (NP)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1049 E NEWELL ST
Mailing Address - Street 2:PO BOX 850
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-8795
Mailing Address - Country:US
Mailing Address - Phone:231-355-7530
Mailing Address - Fax:231-689-7360
Practice Address - Street 1:525 N STATE ST
Practice Address - Street 2:SHELBY ADOLESCENT HEALTH CENTER
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-8201
Practice Address - Country:US
Practice Address - Phone:231-902-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704218644363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP17710015Medicare PIN