Provider Demographics
NPI:1790013290
Name:KELLEY, ELISHIA M (APN, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELISHIA
Middle Name:M
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APN, NNP-BC
Other - Prefix:
Other - First Name:ELISHIA
Other - Middle Name:MARIE
Other - Last Name:SPITLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, NNP-BC
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-0446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5301 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246715363LN0000X
IL209010253363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal