Individual
KELLIE JASMINE BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2333 BIDDLE AVE, WYANDOTTE, MI 48192-4668
(734) 246-6000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011698
MI
Other
Enumeration date
07/16/2020
Last updated
09/22/2025
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