Provider Demographics
NPI:1598952350
Name:MALONE, KELLI A (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:MALONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:937 SAN LUCIA DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3454
Mailing Address - Country:US
Mailing Address - Phone:412-877-9363
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE STE 3100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2563
Practice Address - Country:US
Practice Address - Phone:616-954-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2020-01-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant