Healthcare Provider Details

I. General information

NPI: 1801702972
Provider Name (Legal Business Name): KELLY LYNN TOMS BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GLENBROOK RD UNIT 4077
STORRS CT
06269-4077
US

IV. Provider business mailing address

1626 W VIEW TRL
HOWELL MI
48843-8077
US

V. Phone/Fax

Practice location:
  • Phone: 860-486-1111
  • Fax:
Mailing address:
  • Phone: 810-923-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4704349971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: