Provider Demographics
NPI:1821615006
Name:HOREK, KELSEY LYNN (CNM)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:LYNN
Last Name:HOREK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HILTON RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1048
Mailing Address - Country:US
Mailing Address - Phone:586-596-5486
Mailing Address - Fax:
Practice Address - Street 1:29751 LITTLE MACK AVE STE B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6504
Practice Address - Country:US
Practice Address - Phone:586-415-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704280651367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife