Healthcare Provider Details

I. General information

NPI: 1700708286
Provider Name (Legal Business Name): KAREN KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 LEVERETTE ST
DETROIT MI
48216-1932
US

IV. Provider business mailing address

1643 LEVERETTE ST
DETROIT MI
48216-1932
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-0591
  • Fax:
Mailing address:
  • Phone: 310-795-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number4704434356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: