Healthcare Provider Details

I. General information

NPI: 1124835673
Provider Name (Legal Business Name): KELLY RENAE KOBEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30600 NORTHWESTERN HWY STE 245
FARMINGTON HILLS MI
48334-3171
US

IV. Provider business mailing address

540 N 8 MILE RD
MIDLAND MI
48640-9076
US

V. Phone/Fax

Practice location:
  • Phone: 844-475-9526
  • Fax: 810-471-3921
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12240276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: