Provider Demographics
NPI:1942804562
Name:KELLEY, FAITH YUNG MIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:YUNG MIN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:YUNG MIN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:9802 W 16 RD
Mailing Address - Street 2:
Mailing Address - City:MESICK
Mailing Address - State:MI
Mailing Address - Zip Code:49668-9782
Mailing Address - Country:US
Mailing Address - Phone:231-920-6616
Mailing Address - Fax:
Practice Address - Street 1:148 W PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1128
Practice Address - Country:US
Practice Address - Phone:231-398-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288216390200000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program