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General NPI Number Information
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NPI Number | 1124860671
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Entity Type | Individual
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Provider Name | KELLY COLLEEN MILTIMORE PATRICK BSN, RN, CAS
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Gender | Female
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 5130 ROSE HILL BLVD
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City | HOLLY
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State | MI
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Zip | 48442-9507
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Country | US
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Telephone | 248-634-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 2397 DENTON CT
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City | MILFORD
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State | MI
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Zip | 48380-2027
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Country | US
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Telephone | 734-751-8908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 4704205236
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License Number State | MI
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