Provider Demographics
NPI:1881165835
Name:DIAL, KELSIE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:DIAL
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HOPPE RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9314
Mailing Address - Country:US
Mailing Address - Phone:269-339-7924
Mailing Address - Fax:
Practice Address - Street 1:1201 E MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1853
Practice Address - Country:US
Practice Address - Phone:517-205-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2018015741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health