Provider Demographics
NPI:1740548635
Name:PERRY, KELSEY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:PERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LYNN
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 E CUMMINS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2070
Mailing Address - Country:US
Mailing Address - Phone:517-424-3070
Mailing Address - Fax:517-423-2786
Practice Address - Street 1:693 STOCKFORD DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1460
Practice Address - Country:US
Practice Address - Phone:517-264-0756
Practice Address - Fax:517-263-9796
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant