Provider Demographics
NPI:1982939732
Name:FROST, KELLI LYNN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:LYNN
Last Name:FROST
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LYNN
Other - Last Name:BATTANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15750 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2378
Mailing Address - Country:US
Mailing Address - Phone:734-283-7511
Mailing Address - Fax:734-283-6880
Practice Address - Street 1:15750 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2378
Practice Address - Country:US
Practice Address - Phone:734-283-7511
Practice Address - Fax:734-283-6880
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant