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General NPI Number Information
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NPI Number | 1164167805
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Entity Type | Individual
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Provider Name | KELSEY JOA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 50505 SCHOENHERR RD STE 290
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-3141
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Country | US
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Telephone | 586-314-0080
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Fax | 877-673-3562
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Provider Business Mailing Address
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Address Line | 10270 CLARK RD
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City | DAVISBURG
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State | MI
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Zip | 48350-2708
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Country | US
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Telephone | 586-314-0080
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Fax | 877-673-3562
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704323061
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704323061
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704323061
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License Number State | MI
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