Individual
KELLY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, AGPCNP-C
Contact information
Practice address
2540 16TH ST, PORT HURON, MI 48060-6405
(810) 987-1000
Mailing address
2540 16TH ST, PORT HURON, MI 48060-6405
(810) 987-1000
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704259921
MI
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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