Provider Demographics
NPI:1356113146
Name:POUND, KELLI RENEE (FNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:RENEE
Last Name:POUND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:RENEE
Other - Last Name:BETHURAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3126 LOST PINE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-8407
Mailing Address - Country:US
Mailing Address - Phone:248-890-2201
Mailing Address - Fax:
Practice Address - Street 1:2490 S 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2175
Practice Address - Country:US
Practice Address - Phone:269-343-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner