Healthcare Provider Details

I. General information

NPI: 1831133016
Provider Name (Legal Business Name): KELLY M COLEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 3 MILE RD NW STE 210
WALKER MI
49544-1673
US

IV. Provider business mailing address

2332 KNAPP FOREST CT NE
GRAND RAPIDS MI
49525-9750
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8150
  • Fax: 616-785-0238
Mailing address:
  • Phone: 812-459-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704243275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: