Individual
MS. KELLY CHRISTINE JEW-GARCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
41424 ANN ARBOR RD E, PLYMOUTH, MI 48170-8005
(734) 254-0700
Mailing address
6509 WISTERIA TRCE, ANN ARBOR, MI 48103-6019
(310) 717-7925
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010584
MI
363A00000X
Physician Assistant
PA57791
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315227043
MICHIGAN TASK FORCE CONTROLLED SUBSTANCE LICENSE
MI
01
—
5601010584
MICHIGAN TASK FORCE ON PHYSICIANS ASSISTANTS
MI
01
—
PA57791
PA BOARD OF CALIFORNIA
CA
Enumeration date
02/24/2020
Last updated
07/21/2022
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