Healthcare Provider Details

I. General information

NPI: 1730084872
Provider Name (Legal Business Name): KELSEY PORTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 UNION LAKE RD STE 140
COMMERCE TOWNSHIP MI
48382-3588
US

IV. Provider business mailing address

6501 NOLLAR RD
WHITMORE LAKE MI
48189-9252
US

V. Phone/Fax

Practice location:
  • Phone: 248-363-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704436175
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: