Healthcare Provider Details

I. General information

NPI: 1487022091
Provider Name (Legal Business Name): KEVIN E. FERRELL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50973 COUNTY ROAD 681
LAWRENCE MI
49064-9048
US

IV. Provider business mailing address

50973 COUNTY ROAD 681
LAWRENCE MI
49064-9048
US

V. Phone/Fax

Practice location:
  • Phone: 269-241-2220
  • Fax: 269-674-4239
Mailing address:
  • Phone: 517-898-7718
  • Fax: 269-639-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007459
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: