Provider Demographics
NPI:1013429836
Name:WILLICK, KELSEY M (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:WILLICK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5800 FOREMOST DR SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7062
Mailing Address - Country:US
Mailing Address - Phone:616-954-9800
Mailing Address - Fax:
Practice Address - Street 1:6425 S. HARVEY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-737-3469
Practice Address - Fax:231-737-4548
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2020-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008421363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical