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General NPI Number Information
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NPI Number | 1184286072
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Entity Type | Individual
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Provider Name | KELLEY BETH MCGILLIVRAY NP
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 24353 ORCHARD LAKE RD STE D
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1917
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Country | US
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Telephone | 248-200-3715
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Fax |
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Provider Business Mailing Address
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Address Line | 26206 W 12 MILE RD STE 105
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1799
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Country | US
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Telephone | 248-200-3715
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704300074
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License Number State | MI
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