Provider Demographics
NPI:1689905770
Name:DUNLAP, KELLIE LYNN
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LYNN
Last Name:DUNLAP
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 1:240 WADHAMS RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-4311
Mailing Address - Country:US
Mailing Address - Phone:810-966-3379
Mailing Address - Fax:
Practice Address - Street 1:14960 E PARK ST
Practice Address - Street 2:
Practice Address - City:CAPAC
Practice Address - State:MI
Practice Address - Zip Code:48014-3177
Practice Address - Country:US
Practice Address - Phone:810-395-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker