Healthcare Provider Details

I. General information

NPI: 1679279350
Provider Name (Legal Business Name): KELLY BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 S SAGINAW RD
MIDLAND MI
48640-5633
US

IV. Provider business mailing address

1861 9TH ST
BAY CITY MI
48708-6741
US

V. Phone/Fax

Practice location:
  • Phone: 989-835-4041
  • Fax: 989-835-8121
Mailing address:
  • Phone: 616-914-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: