Provider Demographics
NPI:1942981196
Name:JOYCE, KELLIE (ACCNS-P)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:JOYCE
Suffix:
Gender:F
Credentials:ACCNS-P
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:KIRBITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:856 MULFORD DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3842
Mailing Address - Country:US
Mailing Address - Phone:810-618-3677
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-267-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2000461248364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics