Individual
DR. JESSICA A KILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1035 CHARLEVOIX DR STE 200, GRAND LEDGE, MI 48837-2223
(517) 626-3100
(517) 626-3110
Mailing address
1035 CHARLEVOIX DR STE 200, GRAND LEDGE, MI 48837-2223
(517) 626-3100
(517) 626-3110
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301088707
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
4301088707
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301088707
STATE LICENSE
MI
01
—
OF96004
MEDICARE GROUP NUMBER
—
Enumeration date
10/10/2006
Last updated
04/15/2021
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