Healthcare Provider Details

I. General information

NPI: 1851752976
Provider Name (Legal Business Name): KELLI JEAN VOSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI JEAN KUIPER PA-C

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

1900 44TH ST SE
KENTWOOD MI
49508-5008
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5231
  • Fax: 616-685-5260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007726
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: