Individual
MS. KYOUNG KELLY LEE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3300 WEST CENTRE AVE, BRONSON OB/GYN ASSOCIATES, PORTAGE, MI 49024
(269) 327-2211
(269) 327-0273
Mailing address
PO BOX 42, 601 JOHN STREET, KALAMAZOO, MI 49007
(269) 341-7806
(269) 341-8743
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
4704247830
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4770217
—
MI
Enumeration date
01/20/2006
Last updated
07/08/2007
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