Individual
AMANDA LEE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7128 FULTON ST E, ADA, MI 49301-8413
(616) 825-3530
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006237
MI
Other
Enumeration date
01/24/2012
Last updated
01/06/2025
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