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NPI Code Detail

MEDICARE: MISS KELLI JO DELONG

MEDICARE: MISS KELLI JO DELONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174H00000XHealth Educator

General Provider Information

NPI Number : 1114535465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KELLI JO DELONG
Provider Business Mailing Address
First Line : PO BOX 1667
Second Line :
City : MUSKEGON
State : MI
Zip : 49443-1667
Country : US
Telephone Number : 231-722-9622
Fax Number :
Provider Business Practice Location Address
First Line : 1115 3RD ST
Second Line :
City : MUSKEGON
State : MI
Zip : 49441-2170
Country : US
Telephone Number : 231-722-9622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2020
Last Update Date : 01/06/2023

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Directions to “ MISS KELLI JO DELONG ” Practice Location

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