Individual
KELLY MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2155 E PARIS AVE SE STE 210, GRAND RAPIDS, MI 49546-6195
(616) 655-1570
(616) 655-1571
Mailing address
2155 E PARIS AVE SE STE 210, GRAND RAPIDS, MI 49546-6190
(616) 655-1570
(616) 655-1571
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009852
MI
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
5601009852
MI
Other
Enumeration date
01/27/2020
Last updated
03/18/2026
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