Provider Demographics
NPI:1760973820
Name:KEMP, KELLI R
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:R
Last Name:KEMP
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 1:1970 ATKINSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2009
Mailing Address - Country:US
Mailing Address - Phone:313-910-3286
Mailing Address - Fax:
Practice Address - Street 1:2263 EDISON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2042
Practice Address - Country:US
Practice Address - Phone:313-492-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health