Healthcare Provider Details

I. General information

NPI: 1003526146
Provider Name (Legal Business Name): BRENNA SHAWN KELLEY CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 W NORTON AVE
NORTON SHORES MI
49444-3703
US

IV. Provider business mailing address

1308 PRINCETON RD
MUSKEGON MI
49441-3822
US

V. Phone/Fax

Practice location:
  • Phone: 231-747-0885
  • Fax:
Mailing address:
  • Phone: 231-747-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000174
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: