Healthcare Provider Details

I. General information

NPI: 1740029420
Provider Name (Legal Business Name): KELSEY MARIE CHILD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY MARIE BURNHAM PA-C

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E MIDLAND RD STE A
AUBURN MI
48611-9751
US

IV. Provider business mailing address

312 E MIDLAND RD STE A
AUBURN MI
48611-9751
US

V. Phone/Fax

Practice location:
  • Phone: 989-662-8868
  • Fax: 989-662-1011
Mailing address:
  • Phone: 989-662-8868
  • Fax: 989-662-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: