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NPI Code Detail

MEDICARE: PATRICIA KELLY LMSW

MEDICARE: PATRICIA KELLY LMSW
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
1164W00000XLicensed Practical Nurse4703117696MI
21041C0700XClinical Social Worker6801100817MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215302872
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA KELLY LMSW
Provider Business Mailing Address
First Line : 901 CHIPPEWA ST
Second Line :
City : FLINT
State : MI
Zip : 48503-1552
Country : US
Telephone Number : 810-232-9950
Fax Number : 989-723-8230
Provider Business Practice Location Address
First Line : 1480 N M 52 STE 1
Second Line :
City : OWOSSO
State : MI
Zip : 48867-1025
Country : US
Telephone Number : 989-723-8239
Fax Number : 989-723-8230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2015
Last Update Date : 04/24/2024

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1144743378 — MS. CHLORIA D BOONE
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Directions to “ PATRICIA KELLY LMSW” Practice Location

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