Individual
KELLEY LYNNE GRAY-ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
35735 MOUND RD STE 100, STERLING HEIGHTS, MI 48310-4728
(586) 261-1960
Mailing address
35735 MOUND RD STE 100, STERLING HEIGHTS, MI 48310-4728
(586) 261-1960
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004915
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1074093
NCCPA CERTIFICATE
—
01
—
5601004915
LICENSE
MI
Enumeration date
10/20/2006
Last updated
06/13/2024
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