Healthcare Provider Details

I. General information

NPI: 1811481690
Provider Name (Legal Business Name): KELLY ANNE BAUER DNP, ARNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ANNE JOHNSON DNP, ARNP, AGACNP-BC

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-3768
  • Fax:
Mailing address:
  • Phone: 734-845-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704293269
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP60863924
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704293269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: