Provider Demographics
NPI:1881076164
Name:LLEWELYN, KELLY KAY (DO)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KAY
Last Name:LLEWELYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KAY
Other - Last Name:WISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1560 TURF LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6392
Mailing Address - Country:US
Mailing Address - Phone:517-484-6358
Mailing Address - Fax:
Practice Address - Street 1:1560 TURF LN
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6392
Practice Address - Country:US
Practice Address - Phone:517-484-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022043207V00000X
OK6593207V00000X
MI5101026667207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology