Provider Demographics
NPI:1770670788
Name:KILEY, JESSICA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:KILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1035 CHARLEVOIX DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2223
Mailing Address - Country:US
Mailing Address - Phone:517-626-3100
Mailing Address - Fax:517-626-3110
Practice Address - Street 1:1035 CHARLEVOIX DR STE 200
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2223
Practice Address - Country:US
Practice Address - Phone:517-626-3100
Practice Address - Fax:517-626-3110
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088707207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF96004OtherMEDICARE GROUP NUMBER
MI4301088707OtherSTATE LICENSE