Provider Demographics
NPI:1861036006
Name:KELLY, RACHEL AMBER (ACNPC-AG)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:AMBER
Last Name:KELLY
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W. LAKE LANSING RD
Mailing Address - Street 2:STE 300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4133
Mailing Address - Country:US
Mailing Address - Phone:906-458-1285
Mailing Address - Fax:
Practice Address - Street 1:221 W LAKE RD
Practice Address - Street 2:#300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-253-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293234163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse