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General NPI Number Information
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NPI Number | 1356113146
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Entity Type | Individual
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Provider Name | KELLI RENEE POUND FNP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 2490 S 11TH ST
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City | KALAMAZOO
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State | MI
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Zip | 49009-2175
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Country | US
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Telephone | 269-343-1535
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Fax |
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Provider Business Mailing Address
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Address Line | 3126 LOST PINE WAY
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City | PORTAGE
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State | MI
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Zip | 49024-8407
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Country | US
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Telephone | 248-890-2201
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704252441
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License Number State | MI
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