MEDICARE: KELISE MARIE TERRELL

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
1	374U00000X	Home Health Aide		MI

General Provider Information

NPI Number	:	1962357368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELISE MARIE TERRELL

Provider Business Mailing Address
First Line	:	5257 SPINNING WHEEL CT
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-4251
Country	:	US
Telephone Number	:	810-221-6291
Fax Number	:

Provider Business Practice Location Address
First Line	:	5257 SPINNING WHEEL CT
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-4251
Country	:	US
Telephone Number	:	810-221-6291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ KELISE MARIE TERRELL ” Practice Location

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