Healthcare Provider Details

I. General information

NPI: 1497687644
Provider Name (Legal Business Name): KELLY CAY WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11307 N LINDEN RD STE B
CLIO MI
48420-8589
US

IV. Provider business mailing address

11307 N LINDEN RD STE B
CLIO MI
48420-8589
US

V. Phone/Fax

Practice location:
  • Phone: 810-564-7995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704369242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: